EFFECTS OF STEROID WITHDRAWAL ON LONG-TERM RENAL-ALLOGRAFT RECIPIENTSWITH POSTTRANSPLANTATION DIABETES-MELLITUS

Background. Posttransplantation diabetes mellitus (PTDM), a common com plication of current cyclosporine. We report our experience with stero id withdrawal (SW) in renal allograft recipients with PTDM. Methods. S W was attempted on 12 selected renal allograft recipients with PTDM, a nd its effects on various clinical parameters were recorded before and more than 3 months after SW. Results. Patient and graft survival was 100%, and all patients had a stable serum creatinine level and remaine d steroid free 15.4 +/- 5 months after SW. Ten patients had a signific ant improvement in their diabetic management. Glycosylated hemoglobin decreased from 13.6% +/- 2.3% to 9.2% +/- 2.9% (p = 0.0002); body weig ht decreased from 92 +/- 21 kg to 86 +/- 21 kg (p = 0.0134), and manag ement of hypertension improved in eight of nine (89%) recipients with hypertension. The total cholesterol level decreased from 253 +/- 57 mg /dl to 208 +/- 40 mg/dl (p = 0.0041), but the high-density lipoprotein cholesterol also decreased from 46 +/- 8.9 mg/dl to 39.7 +/- 10.9 mg/ dl (p = 0.073), so that the total cholesterol/high-density lipoprotein ratio was not significantly affected (p = 0.775). Conclusions. SW in selected, stable, long-term renal allograft recipients with PTDM has a favorable effect on glucose homeostasis, body weight, and management of hypertension; its effect on lipid metabolism and subsequent cardiov ascular risk factors warrant further study.