Early Steroid Withdrawal After Kidney Transplantation in Patients at Risk for New-Onset Diabetes After Transplantation |
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| Affiliation: | 1. Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France;2. Université Grenoble Alpes, Grenoble, France;1. Infectious and Tropical Medicine Department, Hospital Center of Cayenne, Cayenne, French Guiana, France;2. Faculté de Médecine, Université de Paris, Paris, France;3. Clinical Investigation Center in Clinical Epidemiology French Guiana « Inserm CIC 1424 », Hospital Center of Cayenne, Cayenne, French Guiana, France;4. EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Medicine University of the West Indies and French Guiana, Cayenne, French Guiana, France;5. Nephrology Department, Hospital Center of Cayenne, Cayenne, French Guiana, France;6. Coordination Régionale de lutte contre le Virus de l''Immunodéficience Humaine, « COREVIH », Hospital Center of Cayenne, French Guiana, France;7. Association pour le Traitement de l''Insuffisance Rénale Guyane « A.T.I.R.G », Cayenne, French Guiana, France;1. Department of Public Health Graduate School, Chonnam National University, Gwangju, Republic of Korea;2. Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea;1. Departments of Internal Medicine H;2. Dermatology;3. Organ Transplantation Unit, Surgical Division;4. Nephrology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;1. Department of Renal Surgery, Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom;2. Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom;1. National Organ Transplant Unit, Ministry of Health, Singapore;2. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore;3. Duke-NUS Medical School, Singapore;1. Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;2. Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;3. Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;4. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;5. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota |
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| Abstract: | BackgroundNew-onset diabetes after transplantation (NODAT) is a serious complication after kidney transplantation because of worse graft survival and increased risk of cardiovascular events. It is partly induced by immunosuppressive therapies such as corticosteroids. This study aimed to assess whether early corticosteroid withdrawal on day 4 (early steroid withdrawal [ESW] group) could prevent the development of NODAT within 2 years posttransplantation while maintaining good graft and patient survival rates.MethodsThis was an observational, single-center, retrospective study. All patients received an induction therapy of antithymocyte globulin or basiliximab and maintenance therapy of tacrolimus/mycophenolate mofetil/corticosteroids. Patients were either weaned off corticosteroids on day 4 (ESW group) or were maintained on corticosteroids for at least 3 months (standard group). NODAT was defined as the initiation of any oral hypoglycemic agent or insulin at 3 months and up to 2 years posttransplantation in previously nondiabetic recipients.ResultsBetween January, 1, 2010, and December 14, 2014, 492 recipients were included in this study; 88 received the ESW strategy, and 404 received the standard strategy. Age and body mass index (BMI) were significantly higher in the ESW group. The incidence of NODAT was 36.8% in the ESW group and 8.8% in the standard group (odds ratio [OR], 47.5; P < .001). Compared with a matched sample from the standard group that had the same probability to benefit from ESW at baseline, ESW was still associated with a significantly increased risk of NODAT (OR, 4.41; P = .018). Among recipients with a BMI >25 kg/m2, the ESW strategy significantly decreased the risk of NODAT compared with the standard strategy (OR, 0.07; P = .013). Safety endpoints (eg, acute rejection, de novo–specific antibodies, graft function/survival) did not differ between groups.ConclusionDespite a reassuring safety profile, ESW on day 4 after kidney transplantation only had a marginal effect on the incidence of NODAT. |
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