Steroid Withdrawal May Not Prevent Post-transplant Diabetes

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Limited effect among adult patients during 5 years following kidney transplantation.
Limited effect among adult patients during 5 years following kidney transplantation.

(HealthDay News) -- For kidney transplant recipients, steroid avoidance has limited impact for reducing new-onset diabetes after transplantation (NODAT), according to a study published in the American Journal of Transplantation.

John D. Pirsch, M.D., from the University of Wisconsin in Madison, and colleagues examined whether steroid avoidance reduces the NODAT risk following kidney transplantation. Data were included from a 5-year early steroid withdrawal double-blind randomized trial. Using 8 definitions, the incidence, timing, and risk factors for NODAT were assessed.

The researchers found that by 5 years, 36.3% of patients on chronic corticosteroids (CCS) and 35.9% on early corticosteroid withdrawal (CSWD) were diagnosed with NODAT by the American Diabetes Association definition. Slightly more cases of NODAT were identified with the definition combining fasting blood glucose ≥126 mg/dL on 2 occasions or treatment (CCS, 39.3% and CSWD, 39.4%). 

The proportion of NODAT patients requiring treatment through 5 years posttransplant was similar (CSWD, 22.5% and CCS, 21.5%); insulin therapy was lower with CSWD than CCS (3.7 versus 11.6%; P = 0.049). Only age was a significant risk factor for NODAT for more than 1 definition in multivariate analysis.

"This prospective, randomized trial of CSWD indicates that CSWD has a limited impact in reducing NODAT when compared to low-dose prednisone (5 mg/day from month 6 to 5 years)," the authors write.

Several authors are employees of Astellas Pharma Global Development and Astellas Scientific and Medical Affairs.

Source

  1. Pirsch, JD, et al. American Journal of Transplantation, volume 15, Issue 7, pages 1982–1990, July 2015; doi: 10.1111/ajt.13247.
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