Early steroid withdrawal--impact on diabetes mellitus and kidney function in heart transplant recipients.
BACKGROUND
The aim of this study was to assess the effect of early steroid withdrawal on renal function, diabetes mellitus (DM) and coronary artery vasculopathy of the transplanted heart (CAV) development and late rejection in orthotopic heart transplant (OHT) recipients.


METHODS
76 patients undergoing OHT in years 2000-2004 (6 women, 50% ischemic, 49±7 years, BMI 24±3.6, glomerular filtration ratio (GFR) - 68-20 ml/kg/min, LVEF 57±6%) receiving maintenance immunosuppression (cyclosporine, prednisone and azathioprine or mycophenolate mofetil) were observed for 5 years in groups, depending on steroid withdrawal time: Group 1 (N=48) - withdrawal later than 12 months post-OHT, Group 2 (N=28) - withdrawal up to 12 months post-OHT. Number of serious rejection episodes (SRE >ISHLT grade 2), time to first SRE after steroid withdrawal (TTSRE), need for steroid reinforcement, CAV presence, need for percutaneous coronary intervention (PCI), DM and abnormal GFR were compared between groups. P<0.05 was significant.


RESULTS
Steroids were administered for 615±188 days in group 1 (G1) and 309±96 days in group 2 (G2). There was a difference between group 1 and 2 in the number of SREs before 12 months (2.4±1.6 vs. 1.6±1.3) and before steroid withdrawal (2.4±1.6 vs. 1.5±1.3), but not in number (0.15±0.62 vs. 0.14±0.36) and percent of patients with an SRE (8.3 vs. 14.3%) after steroid withdrawal. There was no difference in TTSRE (314±312 vs. 199±122 days), need for steroid reinforcement (6.3 vs. 14.3%), time from steroid withdrawal to reinforcement (377±317 vs. 246±130 days), CAV (8.3 vs. 3.6%), PCI (4.2 vs. 3.6%), GFR 60-90 ml/kg/min (30.8 vs. 20.0%), and GFR <60 ml/kg/min (64.1 vs. 80.0%) at 5 years. DM was diagnosed in 58.3 and 71.4% of patients at discharge (p=NS) and in 51.3 and 80% at 5 years in group 1 and 2, respectively (p=0.018).


CONCLUSIONS
Patients with earlier steroid withdrawal presented DM and tended to present more severe stages of kidney failure more often. Despite lower frequency of CAV, they tended to require PCI equally often.
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Disease, Marii Sklodowskiej-Curie 9 St., Zabrze, Poland. neostygmina@interia.pl
Maria K
MK
Lizak
Michał
M
Zakliczyński
Anna
A
Jarosz
Marian
M
Zembala
Zbigniew
Z
Kalarus
D000328:Adult; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors
D007166:Immunosuppressive Agents; D013256:Steroids