Comparison of infectious complications following early versus late pulse steroid therapy in renal transplant recipients

Table 1 Characteristics of patients receiving early and late steroids, n (%)

Variables	Early (n = 84)	Late (n = 44)	P value (df for χ2)
Age in years [median (IQR)]	30 (25-38)	30 (26-37)	0.94
Gender (male)	78 (92.9)	40 (90.0)	0.74 (1)
Dose of pulse steroid in mg [median (IQR)]	1500 (1500-1500)	1500 (1500-1500)	0.48
HLA mismatch [median (IQR)]	3 (3-5)	3 (3-4)	0.94
ABO compatible	77 (91.7)	40 (90.9)	1.0 (1)
Diabetes status			0.52 (2)
Pre-existing DM	1 (1.2)	2 (4.5)
PTDM	9 (10.7)	4 (9.1)
No diabetes	74 (88.1)	38 (86.4)
CMV prophylaxis	40 (47.6)	19 (43.2)	0.63 (1)
Graft loss	2 (2.4)	1 (2.3)	1.0 (1)
Survival status			0.02 (1)
Alive	80 (95.2)	36 (81.8)
Died	4 (4.8)	8 (18.2)

df: Degree of freedom; IQR: Interquartile range (25 percentile to 75 percentile); PTDM: Post-transplant diabetes mellitus; DM: Diabetes mellitus; CMV: Cytomegalovirus.

Table 2 Immunosuppression in patients receiving early and late steroids, n (%)

Variables	Early (n = 84)	Late (n = 44)	P value (df for χ2)
Induction agent			0.54 (2)
Basiliximab	53 (63.1)	25 (56.8)
ATG	21 (25.0)	15 (34.1)
None	10 (11.9)	4 (9.1)
Plasmapheresis	28 (33.3)	21 (47.7)	0.11 (1)
Overall ATG use	27 (32.1)	18 (40.9)	0.32 (1)
Bortezomib1	1 (1.2)	4 (9.1)	0.05 (1)
Mtor inhibitor	2 (2.4)	0 (0.0)	0.54 (1)
Cyclosporine	2 (2.4)	1 (2.3)	1.00 (1)
Azathioprine	2 (2.4)	3 (6.8)	0.34 (1)

¹Bortezomib use was limited to patients treated for antibody-mediated or mixed rejection.

df: Degree of freedom; ATG: Antithymocyte globulin.

Table 3 Infectious complications in patients receiving early and late steroids

Infection	Early (n = 84) (no of episodes per 100 patient years)	Late (n = 44) (no of episodes per 100 patient years)	Incidence rate ratio (95%CI)	P value
Overall infections	42.64	68.68	0.62 (0.46-0.83)	< 0.01
Pneumonia	6.46	14.79	0.44 (0.22-0.86)	0.02
Urinary tract infection	12.27	19.02	0.64 (0.37-1.13)	0.13
Diarrhoea	10.98	19.02	0.58 (0.33-1.02)	0.06
Sepsis	2.58	7.40	0.35 (0.13-0.96)	0.04

CI: Confidence interval.

Table 4 Infections due to specific etiological agents in patients receiving early and late steroids

Infection	Early (n = 84) (total infection episodes)	Early (n = 84) (total infection episodes per 100 patient years)	Late (n = 44) (total infection episodes)	Late (n = 44) (total infection episodes per 100 patient years)	Incidence rate ratio (95%CI)	P value
Bacterial infection	41	13.24	13	13.74	0.96 (0.52-1.80)	0.91
Viral infection	15	4.84	11	11.62	0.42 (0.19-0.91)	0.03
CMV disease	6	1.94	3	3.17	0.61 (0.15-2.44)	0.49
BK viremia	3	0.97	1	1.06	0.92 (0.09-8.82)	0.94
Tuberculosis	4	1.29	2	2.11	0.61 (0.11-3.34)	0.57
Fungal infection	9	2.91	7	7.40	0.39 (0.15-1.05)	0.06
Aspergillosis	3	0.97	2	2.11	0.46 (0.08-2.74)	0.39
Mucor	1	0.32	1	1.06	0.31 (0.02-4.89)	0.40
Parasitic	8	2.58	3	3.17	0.81 (0.22-3.07)	0.76

CI: Confidence interval; CMV: Cytomegalovirus.