Advantages of Low Dose Steroid From the Day After Renal Transplantation

Mcgeown, MaryG.; Douglas, John; Brown, Wendy A.; Donaldson, R. A.; Kennedy, J. A.; Loughridge, W. G. G.; Mehta, Sadanand; Nelson, S D; Doherty, C C; Johnstone, Richard; Todd, Gerald; Hill, ClaireM.

doi:10.1097/00007890-198004000-00005

Cited by 84 publications

(19 citation statements)

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“…In 1964 Starzl [1] described the appearance of 'steroid diabetes' in previously nondiabetic renal transplant recipients. This was confirmed by several other groups [2][3][4][5][6]. Some authors observed post-transplant diabetes mellitus in association with antilymphocyte globulin [7] or antithymocyte globulin therapy [8].…”

Section: Introductionsupporting

confidence: 71%

“…In both reports greater doses of steroids than in the present study were administered during the first months post-transplant. The lowest incidence of 3% was observed by McGeown et al [4], who administered a low-dose steroid regimen (20 mg/day prednisone) early post-transplant. Since CsA has been introduced in the immunosuppressive protocols following kidney transplantation, Gunnarsson et al [16] have noted a deterioration in the glucose metabolism of combined kidney and pancreas allograft recipients who had azathioprine replaced by CsA.…”

Section: Discussionmentioning

confidence: 95%

“…Post-transplant diabetes mellitus has been described in 3%-16% of renal allograft recipients [3][4][5][6][7][8][9][10][11] and one author [2] even reported occurrence in 67 of 145 patients. Most of the literature included patients with transient hyperglycaemia and/or without antidiabetic therapy; therefore, the incidence of post-transplant diabetes mellitus was higher than in the present series.…”

Section: Discussionmentioning

confidence: 99%

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Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

Kiparski

Frei

Uhlschmid³

et al. 1990

Nephrology Dialysis Transplantation

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Abstract. The incidence of post-transplant diabetes mellitus was evaluated retrospectively in 901 consecutive renal transplant recipients. Thirty-two (3.6%) patients developed diabetes mellitus requiring drug therapy. 18 of 32 became hyperglycaemic within 3 months of transplantation. Post-transplant diabetes mellitus occurred in 24 of 628 (3.8%) patients treated with conventional therapy consisting in azathioprine and prednisone, and in 8 of 273 (2.9%) patients receiving cyclosporin A (CsA) in addition (triple therapy). To identify predisposing factors 32 nondiabetic patients matched for age, sex, number of graft, immunosuppressive protocol, and graft function at onset of diabetes were used as case controls. Thirteen of 32 patients with diabetes mellitus and 5 of 32 control patients had abnormal glucose tolerance pretransplant (P< 0.025). HLA-B8 was significantly more frequent in patients with post-transplant diabetes mellitus than in control patients (9 of 29 vs 2 of 31, P<0.02). Twelve (38%) patients became diabetic during or immediately after anti-rejection therapy with intravenous pulse prednisone. Four diabetic patients experienced chronic pancreatitis pre-transplant. Family history of diabetes mellitus, bodyweight, number of rejection episodes, and immunosuppressive drug doses were similar in both groups. Actuarial patient and graft survival was not significantly different in diabetic patients and controls, although 10-year data tended to be better in controls. Thus, post-transplant diabetes mellitus was not a frequent complication in patients sometimes predisposed by an impaired glucose tolerance pre-transplant and was triggered by pulse prednisone therapy in 38%.

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Section: Introductionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

Kiparski

Frei

Uhlschmid³

et al. 1990

Nephrology Dialysis Transplantation

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“…Steroids have long been recog nized as a cause for posttransplant hyperglycemia [35][36][37], They increase the glycogen contents of tissues even in the fasting individual, and glycogen is synthesized at high and even at low blood glucose levels [38]. In our patient, combination therapy of prednisone with azathioprine over more than a decade after the first renal transplanta tion did not induce diabetes mellitus, although consider able weight gain was apparent (1974/67 kg, 1976/90 kg, 1987/89 kg; height 176 cm).…”

Section: Dr Hörimentioning

confidence: 99%

Endocrine and Metabolic Disorders following Kidney Transplantation

Feinstein

Wanner

Böhler³

et al. 1992

Am J Nephrol

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“…As early as 1975, my group suggested a dose reduction to an alternate-day schedule (4). In Ireland, McGeown et al (5) had excellent results for kidney transplantation using very low dosages of prednisone. Numerous abstracts and papers in the 1980s concerning alternate-day steroids would lead one to believe that it was common practice in the transplant community.…”

mentioning

confidence: 99%

Corticosteroids and Kidney Transplantation

Curtis¹

2006

Clinical Journal of the American Society of Nephrology

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Advantages of Low Dose Steroid From the Day After Renal Transplantation

Cited by 84 publications

References 0 publications

Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

Post-Transplant Diabetes Mellitus in Renal Allograft Recipients: A Matched-Pair Control Study

Endocrine and Metabolic Disorders following Kidney Transplantation

Corticosteroids and Kidney Transplantation

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