Effects of steroid withdrawal on posttransplant diabetes mellitus in cyclosporine-treated renal transplant recipients.
Posttransplant diabetes mellitus (PTDM) traditionally has been attributed to therapy with steroids--however, several lines of evidence suggest that cyclosporine also is diabetogenic. A retrospective review revealed that PTDM developed in 9 of 70 previously nondiabetic kidney transplant recipients (12.9%) maintained on prednisone, azathioprine, and CsA compared with 8 of 83 nondiabetics (9.6%) maintained on azathioprine and prednisone alone in an earlier era (P = NS). Among patients maintained on triple-drug therapy, complete withdrawal of prednisone was attempted in 7 renal transplant recipients with PTDM and in 1 recipient of a combined kidney-pancreas transplant who exhibited evidence of type II diabetes mellitus. Seven of the 8 patients were able to discontinue insulin or oral hypoglycemic agents within 4 months of discontinuing steroids. Mean glycohemoglobin level declined from 10.6 +/- 3.6% prior to steroid withdrawal to 6.0 +/- 1.3% within 1 month of steroid cessation, while mean CsA dose and trough CsA blood levels remained unchanged. In 2 patients, mild rejection episodes prompted a return to steroid therapy. Although CsA may be diabetogenic, evidence from this study suggests that withdrawal of steroid therapy is a safe and effective approach to the management of PTDM in patients subsequently maintained on CsA and azathioprine.
Hricik
D E
DE
Transplantation Service, University Hospitals of Cleveland, Ohio 44106.
Bartucci
M R
MR
Moir
E J
EJ
Mayes
J T
JT
Schulak
J A
JA
D001786:Blood Glucose / Q000378:metabolism; D003524:Cyclosporins / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000209:etiology*; D006031:Glycosylation; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D011241:Prednisone / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors
D001786:Blood Glucose; D003524:Cyclosporins; D006454:Hemoglobins; D011241:Prednisone