Effects of steroid withdrawal on long-term renal allograft recipients with posttransplantation diabetes mellitus.

Abstract:

BACKGROUND:Posttransplantation diabetes mellitus (PTDM), a common complication of current immunosuppressive regimens, has been attributed to the diabetogenic effects of prednisone and cyclosporine. We report our experience with steroid withdrawal (SW) in renal allograft recipients with PTDM. METHODS:SW was attempted on 12 selected renal allograft recipients with PTDM, and its effects on various clinical parameters were recorded before and more than 3 months after SW. RESULTS:Patient and graft survival was 100%, and all patients had a stable serum creatinine level and remained steroid free 15.4 +/- 5 months after SW. Ten patients had a significant improvement in their diabetic management. Glycosylated hemoglobin decreased from 13.6% +/- 2.3% to 9.2% +/- 2.9% (p = 0.0002); body weight decreased from 92 +/- 21 kg to 86 +/- 21 kg (p = 0.0134), and management of hypertension improved in eight of nine (89%) recipients with hypertension. The total cholesterol level decreased from 253 +/- 57 mg/dl to 208 +/- 40 mg/dl (p = 0.0041), but the high-density lipoprotein cholesterol also decreased from 46 +/- 8.9 mg/dl to 39.7 +/- 10.9 mg/dl (p = 0.073), so that the total cholesterol/high-density lipoprotein ratio was not significantly affected (p = 0.775). CONCLUSIONS:SW in selected, stable, long-term renal allograft recipients with PTDM has a favorable effect on glucose homeostasis, body weight, and management of hypertension; its effect on lipid metabolism and subsequent cardiovascular risk factors warrant further study.

journal_name

Surgery

journal_title

Surgery

authors

Fabrega AJ,Cohan J,Meslar P,Pollak R

subject

Has Abstract

pub_date

1994-10-01 00:00:00

pages

792-7

issue

4

eissn

0039-6060

issn

1532-7361

journal_volume

116

pub_type

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