Lack of long-term benefits of steroid withdrawal in renal transplant recipients

Glucocorticoids used in renal transplantation have been associated with num erous adverse effects. Most studies that showed short-term benefits of ster oid withdrawal made comparisons for patients administered prednisone, 10 to 17.5 mg/d, versus no prednisone. Few have studied long-term benefits of st eroid withdrawal, We performed a retrospective review and identified 58 pat ients administered cyclosporine, azathioprine, and prednisone who underwent complete steroid withdrawal. Post-steroid withdrawal follow-up was 7.6 +/- 1.9 years. Nine patients restarted prednisone therapy, 3 patients lost the ir grafts (2 of those restarted on prednisone therapy), and 2 patients died with functioning grafts. When prednisone dosage was tapered from 10 mg/d t o 10 mg every other day, clinically significant improvements were seen in w eight, systolic and diastolic blood pressure, blood pressure medications, g lycosylated hemoglobin level, and diabetic medications. No further benefits were seen in these parameters and total cholesterol level on complete ster oid withdrawal from prednisone, 10 mg every other day. Most of the earlier benefits were not sustained on long-term follow-up, and the increase in the se parameters was similar to that of a similar matched control group (that underwent transplantation during the same period) maintained on prednisone, 5 mg/d. Major differences were decreases in creatinine clearances and hemo globin levels, which were greater in the steroid-withdrawal group (7.4 +/- 1.9 mL/min and 1.2 +/- 0.2 g/dL, respectively) compared with the control gr oup (2.6 +/- 1.5 mL/min and 0.5 +/- 0.2 g/dL, respectively). In conclusion, most of the metabolic benefits were seen with steroid dosage taper from pr ednisone, 10 mg/d to 10 mg every other day, with no further benefits with s teroid withdrawal. Most of these benefits were not sustained on long-term f ollow-up, questioning the utility of steroid withdrawal. (C) 2001 by the Na tional Kidney Foundation, Inc.