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

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.