Body weight alterations under early corticosteroid withdrawal and chronic corticosteroid therapy with modern immunosuppression.
BACKGROUND
Weight gain is a known complication of corticosteroid maintenance therapy. The purpose of the present study was to compare patterns of weight gain under chronic corticosteroid therapy (CCST) with that observed under early (i.e., within 7 days posttransplant) corticosteroid withdrawal (CSWD) in renal-transplant recipients.


METHODS
Renal-transplant recipients who underwent early CSWD under four prospective, institutional review board-approved clinical trials were compared with a historic control group of patients receiving maintenance CCST.


RESULTS
One hundred sixty-nine patients with early CSWD were compared with 132 patients who received CCST. Mean population weight gain was significantly higher in CCST patients at 3, 6, and 12 months posttransplant. Race influenced weight gain because white CSWD patients demonstrated greater reductions in weight gain compared with African-American patients. Sex also influenced weight gain: women demonstrated a greater benefit from CSWD than did men. Corticosteroid rejection therapy in CSWD patients completely restored weight gain because these patients showed weight gains similar to the CCST group. Finally, pretransplant body mass index (BMI) also influenced weight gain because patients who were overweight (BMI 25-30) or obese (BMI>30) demonstrated a greater reduction in weight gain with CSWD than did patients of normal weight (BMI<25).


CONCLUSIONS
Early CSWD minimizes weight gain in renal-transplant recipients. Women, whites, and patients with high pretransplant BMI had greater reductions in weight gain with early CSWD.
Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, OH 45267-0558, USA.
Christin C
CC
Rogers
Rita R
RR
Alloway
Joseph F
JF
Buell
Robyn
R
Boardman
J Wesley
JW
Alexander
Michael
M
Cardi
Prabir
P
Roy-Chaudhury
M Roy
MR
First
Paul
P
Succop
Rino
R
Munda
E Steve
ES
Woodle
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000382:microbiology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D015430:Weight Gain / Q000187:drug effects*
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus