Stop Post-transplant Corticosteroids Sooner?

Immunosuppressive drug treatment is known to contribute to weight gain in transplant recipients—and weight gain can be particularly dangerous in patients with a high incidence of cardiovascular disease and death. Researchers from University of Cincinnati and The Christ Hospital in Cincinnati, Ohio, suggest that withdrawing corticosteroids within seven days after organ transplantation can help keep weight gain down.

They compared 169 renal transplant patients whose corticosteroid therapy was stopped early with 132 patients who received maintenance chronic cortico-steroid therapy. The mean weight gain was approximately 30% higher among the maintenance patients at three, six, and 12 months—and occurred at a 33% faster rate. In fact, the early-withdrawal patients tended to lose weight in the first month after transplantation, whereas those patients who maintained their regimen of corticosteroids gained weight.
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At one year, the maintenance therapy group experienced a significantly higher mean weight gain of 7.7 kg; by contrast, the withdrawal group gained 2.4 kg. A subset analysis showed similar proportions of patients in both groups who lost weight; however, the withdrawal group comprised more patients whose weight remained stable (defined as a gain or loss of less than 5 kg), and fewer patients in this group gained weight.

Women, Caucasians, patients with a pre-transplant body mass index greater than 30, and recipients of living-donor transplants appeared to benefit most from early withdrawal of corticosteroids.