Effect of race on the occurrence of posttransplant diabetes in kidney transplant recipients treated with early steroid discontinuation.
BACKGROUND
Early steroid discontinuation (within 5 days after transplant) has been associated with a lower incidence of posttransplant diabetes mellitus (PTDM). A retrospective study was done to assess the incidence of PDTM in relation to racial groups in kidney transplant recipients who received early steroid discontinuation.


METHODS
Between January 2002 and January 2004, 125 consecutive, primary adult kidney transplant recipients (51 cadaveric donor, 74 living donor) were performed at the University of Illinois at Chicago. The first 34 recipients were treated with steroid maintenance therapy, while the remaining 91 underwent early steroid discontinuation. Group A (n = 91) had steroids discontinued on postoperative day 6 and maintenance immunosuppression consisting of tacrolimus and mycophenolate mofetil. Group B (n = 34) received the same immunosuppression but was maintained on steroids indefinitely. Induction consisted of Thymoglobulin in African-Americans; all others received Simulect.


RESULTS
At 1 year, patient and graft survivals were similar in both groups; there was a trend for reduction of acute rejection rates in group A (4% vs 12%). The incidence of PTDM was significantly lower in group A (7%) compared to group B (26%; P = .0209). The incidence of PTDM in group A was limited to Hispanic patients. African-Americans and Caucasians in group A did not experience PTDM (P = .005 compared to African-Americans in group B).


CONCLUSIONS
A steroid-free protocol virtually eliminated the incidence of PTDM in African-Americans and Caucasians but had no effect on the development of PTDM in Hispanic recipients. Alternative immunosuppression may benefit this population.
Walczak
D
D
Department of Surgery, Division of Transplantation, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Calvert
D
D
Oberholzer
J
J
Testa
G
G
Sankary
H
H
Benedetti
E
E
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D002641:Chicago; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004334:Drug Administration Schedule; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D044469:Racial Groups; D012189:Retrospective Studies; D016019:Survival Analysis
D000305:Adrenal Cortex Hormones