POSTTRANSPLANTATION DIABETES IS BETTER CONTROLLED AFTER CONVERSION FROM PREDNISONE TO DEFLAZACORT - A PROSPECTIVE TRIAL IN RENAL-TRANSPLANTS

It is well known that long-term use of steroids plays a decisive role in the development of glucose intolerance and diabetes mellitus (DM). Deflazacort, an oxazoline derivative of prednisolone, has been introdu ced as a potential substitute for conventional steroids in order to am eliorate glucose intolerance. We initiated a randomized study of conve rsion from prednisone to deflazacort in kidney transplantation (Tx) re cipients presenting with pre-Tx or post-Tx DM to ascertain whether or not the switch to deflazacort would ameliorate the diabetic state. For ty-two recipients in the conversion group were compared with 40 patien ts on prednisone (the control group) in a prospective manner. The dose reduction of insulin or oral blood glucose-lowering agents, the adequ acy of glucose control, and the development of side effects were the c riteria for evaluating outcome. In the conversion group, patients were switched to deflazacort at a dose ratio of 6 mg deflazacort to 5 mg p rednisone. During the mean follow-up period of 13.2 months, neither gr aft dysfunction nor acute rejection developed in the conversion group. Improvement in blood glucose control in the conversion group was note d. When the conversion group was stratified into pre- or post-Tx DM, p romising effects were clearly evident in the post-Tx DM patients. More than 50 % dose reduction of blood glucose-lowering agents was possibl e in 42.3 % of post-Tx DM patients. In conclusion, it was readily poss ible to control blood glucose better in post-Tx DM recipients without seriously affecting the immunosuppressive activity after conversion to deflazacort.