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Jana Ekberg: Steroid-free treatment effective and safe in kidney transplants

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The Institute of Clinical Sciences

Kidney transplantation is the best treatment for chronic kidney failure, but medications to prevent rejection can cause severe side effects. Jana Ekberg’s research shows that steroid-free immunosuppressive treatment is effective both short and long term after kidney transplantation.

Jana Ekberg is a nephrologist at the Transplantation Center at Sahlgrenska University Hospital and a doctoral student at the Institute of Clinical Sciences.

JANA EKBERG
Dissertation defense: 16 January 2025 (click for details)
Doctoral thesis: Steroid-free immunosuppression in kidney transplantation
Research area: Transplantation Surgery
Sahlgrenska Academy, The Institute of Clinical Sciences

Jana Ekberg, a nephrologist at the Transplantation Center at Sahlgrenska University Hospital, works daily with patients undergoing kidney transplantation. With extensive experience in immunosuppressive medications, she has studied whether it is possible to avoid steroids and reduce side effects, such as post-transplant diabetes, without compromising the treatment’s effectiveness.

Cover image. "Kidney Tree" by artist Jitka Palmer, inspired by the word "graft". "Grafting" refers to joining something external with a host, medically or botanically, like a transplanted organ or a grafted fruit branch. For better life, for better fruit.

Equally effective without steroids

What did the research show?
“We followed 222 kidney transplant recipients in a large randomized controlled trial. Half received standard treatment with three immunosuppressive drugs, and half received steroid-free treatment with two drugs. The results after two years showed that the steroid-free treatment was equally effective as the standard treatment, without an increased risk of rejection,” says Jana Ekberg, who is pursuing her doctorate at the Institute of Clinical Sciences.

She continues: “When we extended the follow-up period to seven years, we saw the same results – the treatment was effective and safe even in the long term. Notably, the majority of patients in the steroid-free group avoided taking steroids for the full seven years.”

Incidence of post-transplant diabetes after 1 year. Comparison between the steroid-free patient group (left) and the standard treatment group (right). No statistical difference.

Inspiring collaboration

Jana Ekberg’s research project, known as the SAILOR trial, was conducted in collaboration with two other Scandinavian transplant centers.

“The collaboration between the three Scandinavian centers in Gothenburg, Aarhus, and Malmö has been very inspiring. We look forward to more joint research projects. The study is also an example of excellent cooperation between the Transplantation Center at Sahlgrenska University Hospital and regional clinics across the country that followed the participants during the project.”

Incidence of biopsy-proven rejection after 1 year. Steroid-free group (left), standard treatment group (right), and rejection type (TCMR, T cell-mediated rejection; ABMR, antibody-mediated rejection). No statistical difference.

Clinically focused project

What else has been enjoyable and rewarding about your doctoral project?
“The project was very clinically focused. Behind every number, I could recall an actual patient. It was very gratifying that so many were willing to participate in the research. I am also glad that we can now offer more patients a steroid-free treatment, helping them avoid the side effects associated with steroids.”

And what has been the most challenging?
“The hardest part has been balancing clinical work with research. In addition, the growing administrative burden around research was sometimes frustrating.”

Text: Jakob Lundberg

Area
Health and medicine
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