Steroid Withdrawal: The Key to Preventing Diabetes After Transplant?
For most diabetic individuals, their diagnosis is closely connected to their pancreas. However, there are other organs that can lead to the onset of diabetes – specifically, transplanted ones. “New-onset diabetes” can sometimes develop after an organ transplant as a side effect of anti-rejection medication.
However, a new study published in The Lancet reveals a possible key to preventing new-onset diabetes.
Previous studies indicated that prolonged steroid use was most effective in preventing rejection of kidney transplants, but included the high risk of new-onset diabetes. According to study author Christian Hugo, MD, of University Hospital Carl Gustav Carus Dresden in Germany, this team of researchers sought to find out “whether we could do a study in which rapid steroid withdrawal could eliminate this disadvantage of high post-transplant diabetes mellitus rates.”
Researchers gathered 587 kidney transplant patients and put them on one of three types of anti-rejection treatments. The first group received a basiliximab induction with low-dose tacrolimus, 2 g mycophenolate mofetil, and steroid maintenance therapy; the second received basiliximab induction with low-dose tacrolimus, 2 g mycophenolate mofetil, and rapid steroid withdrawal on day 8; the third received rabbit antithymocyte globulin (ATG) induction with low-dose tacrolimus, 2 g mycophenolate mofetil, and rapid steroid withdrawal on day 8.
Their findings were promising. None of the treatments showed a significant drop in efficacy in terms of organ rejection, and new-onset diabetes instances in the rapid steroid withdrawal groups (groups two and three) dropped from 39 to 24 percent. Even more encouraging was the long-lasting effect – Dr. Hugo indicated that "after 2 months and up to 12 months... this effect of a difference after rapid steroid withdrawal also occurred when you started evaluation on day 0, 4 weeks, 8 weeks, 12 weeks -- whatever."
Doctors agree that the main cause of death after an organ transplant is cardiovascular disease – a condition that diabetes can exacerbate. With this in mind, Dr. Hugo and his colleagues' research could be a ray of hope for many individuals in need of organ transplant.