STEROID-RELATED COMPLICATIONS IN THE CYCLOSPORINE ERA

Steroid withdrawal has potential risks (rejection) and benefits (fewer complications). Most data on steroid-related complications predates c yclosporine (CsA). We tabulated the incidence of posttransplant compli cations considered to be steroid-related in 748 adult kidney transplan t recipients (with at least 1 year of follow-up) on CsA and prednisone . Using logistic regression analysis, we considered the effects of pre - and postoperative variables for these complications: cataracts; new- onset posttransplant diabetes; bone/joint complications; avascular nec rosis; and posttransplant hypertension. Variables included pretranspla nt steroid therapy; initial steroid dose; prednisone dose at 1 month a nd 1 year; steroid-treated rejection episodes; cumulative time on ster oids; sex; age; race; pretransplant hypertension; pretransplant diabet es; donor source; nonsteroid treated rejection episodes; other immunos uppressive therapy; cumulative time on dialysis; and previous renal or extrarenal transplants. Cataracts occurred in 21.1%, new-onset posttr ansplant diabetes in 7.6%, bone/joint complications in 49.9%, avascula r necrosis in 5.5%, and posttransplant hypertension in 74.9% of recipi ents. Significant variables for cataract development were prednisone d ose at 1 year (odds ratio [OR]= 1.32; p < 0.05), cumulative time on st eroids (OR = 1.65; p < 0.001), age > 50 years (OR = 1.85; p < 0.0001), and pretransplant diabetes (OR = 1.63; p < 0.0001). For new-onset pos ttransplant diabetes, age > 50 years (OR = 1.63; p<0.05) and nonwhite race (OR=2.12; p<0.001) were significant. For bone/joint complications , cumulative time on steroids was significant (OR = 1.45; p < 0.001). No factors were significant for avascular necrosis. Significant variab les for posttransplant hypertension were pretransplant hypertension, p rednisone dose at 1 month (OR = 1.5; p < 0.05), and male sex (OR = 15; p < 0.0 1). Steroid-related complications still account for significa nt morbidity in CSA-treated transplant recipients. Risk factors includ e prednisone dose at 1 month and 1 year as well as cumulative time on steroids.