Steroid-related complications in the cyclosporine era.
Steroid withdrawal has potential risks (rejection) and benefits (fewer complications). Most data on steroid-related complications predates cyclosporine (CsA). We tabulated the incidence of posttransplant complications considered to be steroid-related in 748 adult kidney transplant recipients (with at least 1 year of follow-up) on CsA and prednisone. Using logistic regression analysis, we considered the effects of pre- and postoperative variables for these complications: cataracts; new-onset post-transplant diabetes; bone/joint complications; avascular necrosis; and posttransplant hypertension. Variables included pretransplant steroid therapy; initial steroid dose; prednisone dose at 1 month and 1 year; steroid-treated rejection episodes; cumulative time on steroids; sex; age; race; pretransplant hypertension; pretransplant diabetes; donor source; nonsteroid treated rejection episodes; other immunosuppressive therapy; cumulative time on dialysis; and previous renal or extrarenal transplants. Cataracts occurred in 21.1%, new-onset posttransplant diabetes in 7.6%, bone/joint complications in 49.9%, avascular necrosis in 5.5%, and post-transplant hypertension in 74.9% of recipients. Significant variables for cataract development were prednisone dose at 1 year (odds ratio [OR] = 1.32; p < 0.05), cumulative time on steroids (OR = 1.65; p < 0.001), age > 50 years (OR = 1.85; p < 0.0001), and pretransplant diabetes (OR = 1.63; p < 0.0001). For new-onset posttransplant diabetes, age > 50 years (OR = 1.63; p < 0.05) and nonwhite race (OR = 2.12; p < 0.001) were significant. For bone/joint complications, cumulative time on steroids was significant (OR = 1.45; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Fryer
J P
JP
Department of Surgery, University of Minnesota, Minneapolis.
Granger
D K
DK
Leventhal
J R
JR
Gillingham
K
K
Najarian
J S
JS
Matas
A J
AJ
D000328:Adult; D000367:Age Factors; D001424:Bacterial Infections; D001847:Bone Diseases / Q000139:chemically induced; D002386:Cataract / Q000139:chemically induced; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D007165:Immunosuppression Therapy; D015994:Incidence; D007592:Joint Diseases / Q000139:chemically induced; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses; D010020:Osteonecrosis / Q000139:chemically induced; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects*; D044469:Racial Groups; D012737:Sex Factors
D016572:Cyclosporine; D011241:Prednisone