{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:39:32Z","timestamp":1786372772197,"version":"build-2736575974"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,1]]},"abstract":"\n Background and objectives<\/jats:title>\n There is continued debate whether early steroid withdrawal is safe to use in high\u2013immunologic risk patients, such as blacks. The goal of this study was to use comparative effectiveness methodology to elucidate the safety of early steroid withdrawal in blacks with kidney transplants.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n Our cohort study used United Network of Organ Sharing data including all adult black kidney transplant recipients from 2000 to 2009 followed through 2014. Propensity score matching was used to equalize baseline risk between continued steroid and early steroid withdrawal groups. Interaction terms were used to assess if the effect of early steroid withdrawal on outcomes varied by baseline and post-transplant factors. Of 26,582 eligible black patients with kidney transplants (5825 [21.9%] with early steroid withdrawal), 5565 patients with early steroid withdrawal were matched to 5565 blacks on continued steroid use.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Black patients with early steroid withdrawal had similar risk of graft loss (hazard ratio, 0.98; 95% confidence interval, 0.92 to 1.04;\n P<\/jats:italic>\n =0.42) and lower risk of death (hazard ratio, 0.91; 95% confidence interval, 0.84 to 0.99;\n P<\/jats:italic>\n =0.02), primarily driven by a late mortality advantage (>4 years post-transplant). Delayed graft function, cytolytic induction, tacrolimus, and mycophenolate significantly modified the effect of early steroid withdrawal on outcomes (\n P<\/jats:italic>\n <0.05). Acute rejection rates were slightly higher in the continued steroid group (13.0% versus 11.3%, respectively;\n P<\/jats:italic>\n <0.01), but this was not associated with graft or patient survival.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Overall, early steroid withdrawal in black kidney transplant recipients was not associated with graft loss but seemed to be associated with better long\u2013term patient survival. Early steroid withdrawal in blacks not receiving cytolytic induction, tacrolimus, and mycophenolate or those with delayed graft function was associated with higher risk of graft loss and death.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.04880516","type":"journal-article","created":{"date-parts":[[2016,12,15]],"date-time":"2016-12-15T22:15:11Z","timestamp":1481840111000},"page":"131-139","source":"Crossref","is-referenced-by-count":26,"title":["A Comparative Effectiveness Analysis of Early Steroid Withdrawal in Black Kidney Transplant Recipients"],"prefix":"10.2215","volume":"12","author":[{"given":"David J.","family":"Taber","sequence":"first","affiliation":[{"name":"Divisions of Transplant Surgery and"},{"name":"Department of Pharmacy Services and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly J.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulugeta","family":"Gebregziabher","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titte","family":"Srinivas","sequence":"additional","affiliation":[{"name":"Transplant Nephrology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth D.","family":"Chavin","sequence":"additional","affiliation":[{"name":"Divisions of Transplant Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhakar K.","family":"Baliga","sequence":"additional","affiliation":[{"name":"Divisions of Transplant Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard E.","family":"Egede","sequence":"additional","affiliation":[{"name":"Department of Medicine, Veteran Affairs Health Services Research and Development, Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,12,15]]},"reference":[{"issue":"Suppl 2","key":"B1-20230813","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ajt.13195","article-title":"OPTN\/SRTR 2013 annual data report: Kidney.","volume":"15","author":"Matas","year":"2015","journal-title":"Am J Transplant"},{"key":"B2-20230813","first-page":"417","article-title":"Summary of kidney transplant data, 1977-factors affecting graft outcome.","volume":"10","author":"Terasaki","year":"1978","journal-title":"Transplant Proc"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/j.1600-6143.2004.00332.x","article-title":"Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era.","volume":"4","author":"Meier-Kriesche","year":"2004","journal-title":"Am J Transplant"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/j.1600-6143.2011.03840.x","article-title":"Understanding the causes of kidney transplant failure: The dominant role of antibody-mediated rejection and nonadherence.","volume":"12","author":"Sellar\u00e9s","year":"2012","journal-title":"Am J Transplant"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"5785","DOI":"10.4049\/jimmunol.1390055","article-title":"Calcineurin inhibitors: 40 years later, can\u2019t live without...","volume":"191","author":"Azzi","year":"2013","journal-title":"J Immunol"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1007\/s00467-012-2391-6","article-title":"Steroid withdrawal in renal transplantation.","volume":"28","author":"Grenda","year":"2013","journal-title":"Pediatr Nephrol"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1093\/ndt\/gfr374","article-title":"Very early steroid withdrawal or complete avoidance for kidney transplant recipients: A systematic review.","volume":"27","author":"Pascual","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1097\/00007890-200011150-00015","article-title":"Double-blind comparison of two corticosteroid regimens plus mycophenolate mofetil and cyclosporine for prevention of acute renal allograft rejection.","volume":"70","author":"Vanrenterghem","year":"2000","journal-title":"Transplantation"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/SLA.0b013e318187d1da","article-title":"A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.","volume":"248","author":"Woodle","year":"2008","journal-title":"Ann 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Res"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1056\/NEJMoa1009546","article-title":"Alemtuzumab induction in renal transplantation.","volume":"364","author":"Hanaway","year":"2011","journal-title":"N Engl J Med"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1016\/j.transproceed.2010.02.081","article-title":"Influence of African-American ethnicity on acute rejection after early steroid withdrawal in primary kidney transplant recipients.","volume":"42","author":"Padiyar","year":"2010","journal-title":"Transplant Proc"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1097\/01.TP.0000089440.47239.3F","article-title":"Withdrawal of steroid therapy in African American kidney transplant recipients receiving sirolimus and 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american kidney transplant recipients monitored by surveillance biopsy: 1-year results.","volume":"5","author":"Anil Kumar","year":"2005","journal-title":"Am J Transplant"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1097\/00007890-199411000-00011","article-title":"The distribution of HLA antigens and phenotypes among donors and patients in the UNOS registry.","volume":"58","author":"Leffell","year":"1994","journal-title":"Transplantation"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1056\/NEJM199209173271202","article-title":"Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry.","volume":"327","author":"Takemoto","year":"1992","journal-title":"N Engl J Med"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1097\/00007890-200212150-00024","article-title":"HLA matching and the United Network for Organ Sharing Allocation System: Impact of HLA matching on African-American recipients of cadaveric kidney transplants.","volume":"74","author":"Rebellato","year":"2002","journal-title":"Transplantation"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/00007890-199102000-00013","article-title":"Possible contribution of pretransplant immune responder status to renal allograft survival differences of black versus white recipients.","volume":"51","author":"Kerman","year":"1991","journal-title":"Transplantation"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S0966-3274(02)00171-5","article-title":"Combined analysis of cytokine genotype polymorphism and the level of expression with allograft function in African-American renal transplant patients.","volume":"11","author":"McDaniel","year":"2003","journal-title":"Transpl Immunol"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1097\/00007890-200103150-00021","article-title":"Increased costimulatory responses in African-American kidney allograft recipients.","volume":"71","author":"Hutchings","year":"2001","journal-title":"Transplantation"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1093\/ndt\/gfn667","article-title":"Association between delayed graft function and allograft and patient survival: A systematic review and meta-analysis.","volume":"24","author":"Yarlagadda","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"B32-20230813","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.humimm.2015.09.047","article-title":"Improved flow cytometry based cytotoxicity and binding assay for clinical antibody HLA crossmatching.","volume":"76","author":"Alheim","year":"2015","journal-title":"Hum Immunol"},{"key":"B33-20230813","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0966-3274(00)00006-X","article-title":"The application of flow cytometry to histocompatibility testing.","volume":"8","author":"Horsburgh","year":"2000","journal-title":"Transpl Immunol"},{"key":"B34-20230813","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1111\/j.1600-6143.2006.01521.x","article-title":"Transplanting the highly sensitized patient: The emory algorithm.","volume":"6","author":"Bray","year":"2006","journal-title":"Am J Transplant"},{"key":"B35-20230813","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1046\/j.1523-1755.2000.00816.x","article-title":"Long-term survival in renal transplant recipients with graft function.","volume":"57","author":"Ojo","year":"2000","journal-title":"Kidney Int"},{"key":"B36-20230813","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1093\/ndt\/16.8.1545","article-title":"Causes of death after renal transplantation.","volume":"16","author":"Briggs","year":"2001","journal-title":"Nephrol Dial Transplant"},{"key":"B37-20230813","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.trre.2013.01.002","article-title":"Scientific Registry of Transplant Recipients: Collecting, analyzing, and reporting data on transplantation in the United States.","volume":"27","author":"Leppke","year":"2013","journal-title":"Transplant Rev (Orlando)"},{"key":"B38-20230813","first-page":"1","article-title":"The UNOS renal transplant registry: Review of the last decade.","volume":"2014","author":"Andre","year":"2014","journal-title":"Clin Transpl"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201701000-00018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:29Z","timestamp":1786368989000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201701000-00018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,15]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.04880516","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,15]]}}}