Steroid immunosuppression in kidney transplantation: a passing era

Schulak, James A.

doi:10.1016/j.jss.2003.11.005

Cited by 13 publications

(9 citation statements)

References 46 publications

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“…In particular, corticosteroids have long been implicated in increasing CV risk by causing multiple metabolic effects, including HTN, DM, dyslipidemia, and weight gain. Because of these numerous negative CV effects, corticosteroid withdrawal or corticosteroid avoidance has become an important focus in the implementation of immunosuppressive regimens to decrease CV risk (17). To answer some of these questions, this study sought to evaluate differences in FRS and CVE between those receiving corticosteroids and those that had early withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids

Rike¹,

Mogilishetty²,

Alloway³

et al. 2007

Clinical Transplantation

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Section: Discussionmentioning

confidence: 99%

Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids

Rike¹,

Mogilishetty²,

Alloway³

et al. 2007

Clinical Transplantation

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“…30 However, complete withdrawal of corticosteroids -which has been routine practice in some units for some years 8 -remains a somewhat controversial strategy. 31 Alternative approaches include corticosteroidsparing regimens with adjunctive antibody induction treatment. Both ciclosporin and tacrolimus are known to be diabetogenic, especially when combined with corticosteroids.…”

Section: Assessing Risk Of Nodat Prior To Transplantationmentioning

confidence: 99%

New‐onset diabetes after transplantation

Krentz

Wheeler

2006

Pract Diab Int

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New-onset diabetes after transplantation (NODAT) is a common and clinically important complication of solid-organ transplantation. Consensus guidelines have recently been published with the aim of increasing awareness of NODAT among the transplant and diabetes communities. Current evidence suggests that the development of posttransplant diabetes has adverse effects on recipient and graft survival. While the pathogenesis of NODAT remains incompletely understood, insulin resistance and insulin deficiency have been identified as key metabolic abnormalities. These defects may be aggravated by certain classes of immunosuppressive drugs, notably corticosteroids and the immunophilins, tacrolimus and ciclosporin. The incidence and prevalence of NODAT, and lesser degrees of glucose intolerance which may also be clinically relevant, were almost certainly underestimated in many early studies. The consensus guidelines call for abandonment of arbitrary diagnostic criteria in favour of current internationally accepted definitions for diabetes and states of glucose intolerance. Recent demographic trends warn of an increasing threat from NODAT: the age of transplant recipients is rising and this population has become more obese. With risk factors for NODAT now identified (older age, obesity, non-white ethnicity, family history of diabetes and hepatitis C infection), it may be possible to reduce the incidence in susceptible individuals listed for transplantation. Lifestyle measures directed at controlling body weight -before and after transplantation -allied to tailored immunosuppressive therapy are recommended. However, since the efficacy and safety of these measures have not been rigorously evaluated in clinical trials, many uncertainties remain. Oral antidiabetic agents and/or insulin treatment are required in a proportion of patients, sometimes temporarily. In addition to the risks of atherothrombotic cardiovascular disease, patients with irreversible NODAT should be considered to be at risk of long-term microvascular complications including retinopathy, foot disease and nephropathy. Further studies are required to ascertain the current incidence, prevalence and natural history of NODAT in order to identify more effective strategies for prevention and management.

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“…For instance, steroid therapy has been the subject of numerous debates. Early withdrawal within the first 2 weeks following transplantation (2) and steroid-free transplantation recently emerged as possible therapeutic options; however, long-term data are lacking (2)(3)(4)(5). The recently published guidelines for long-term management of transplant recipients proposed that late steroid withdrawal 3 months posttransplantation (2) should be considered to avoid serious long-term adverse effects of steroids (6).…”

mentioning

confidence: 99%

Recipient Age and Mycophenolate Mofetil As the Main Determinants of Outcome after Steroid Withdrawal: Analysis of Long-Term Follow-up in Renal Transplantation

Laouad

Büchler²,

Al-Najjar³

et al. 2005

Transplantation

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The long-term benefit of steroid withdrawal on patient and graft survival is unproven. Steroids were stopped within the first year after kidney transplantation in 223 consecutive low-risk patients initially treated with thymoglobulin and triple-drug therapy. The 15-year actuarial graft survival rate was 83.9%. Risk factors for graft loss were: proteinuria (hazard ratio [HR]: 6.96, P = 0.0003), creatinine >130 micromol/L (HR: 3.37, P = 0.01), recipient age <35 years (HR: 5.31, P = 0.001), and no mycophenolate mofetil (MMF) treatment (HR: 8.83, P = 0.04). Interestingly, recipient age and no MMF treatment were not risk factors in higher-risk patients in whom steroids were continued. The 2-year incidence of acute rejection following steroid withdrawal was 12.1%; the graft survival rate was lower in this group (71.1%). Our findings indicate that late steroid withdrawal results in excellent long-term outcome in most low-risk patients, but it should be attempted with caution in younger patients and when MMF is not used.

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Steroid immunosuppression in kidney transplantation: a passing era

Cited by 13 publications

References 46 publications

Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids

Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids

New‐onset diabetes after transplantation

Recipient Age and Mycophenolate Mofetil As the Main Determinants of Outcome after Steroid Withdrawal: Analysis of Long-Term Follow-up in Renal Transplantation

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