Abstract
Background: Steroid withdrawal (SW) after kidney transplantation is desirable to avoid associated
serious side effects. We studied the long-term outcome of a group of kidney transplant
recipients who underwent SW. Methods: Between 1991 and 1993, kidney transplant recipients (N = 12) who had posttransplantation
diabetes were entered in a prospective trial of SW. These patients were compared with
a demographically similar comparison cohort (N = 66). End points of the study were
patient and graft survival, incidence of late acute and chronic rejection, and changes
in diabetes management. Results: Previously published data from the SW group at 15 months of follow-up indicated improvement
in diabetes control without any adverse effect on patient or graft actuarial survival.
At long-term follow-up (mean, 56 months) the improvement in diabetes management was
not detectable. The incidence of late acute rejection in SW and cohort groups was
42% and 8%, respectively (P = .006). Likewise, the incidence of chronic rejection in the SW versus cohort group
was 42% and 12%, respectively (P = .014). Conclusions: Although SW appeared to be successful initially, our long-term data indicate that
SW significantly increases the risk of late acute rejection and chronic rejection
episodes without benefits in posttransplantation diabetes management. Steroid withdrawal
in patients with posttransplantation diabetes should be approached with caution. (Surgery
1999;125:155-9.)
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Article info
Publication history
Accepted:
August 18,
1998
Footnotes
☆Supported in part by the Eleanor B. Pillsbury Fellowship.
☆☆Reprint requests: Enrico Benedetti, MD, University of Illinois at Chicago, Department of Surgery, Division of Transplantation, 840 S Wood St, Room 402 M/C 958, Chicago, IL 60612.
Identification
Copyright
© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
