Steroid-related complications in the cyclosporine era

Steroid withdrawal has potential risks (rejection) and benefits (fewer complications). Most data on steroid-related complications predates cyclosporine (CsA). We tabulated the incidence of posttransplant complications considered to be steroid-related in 748 adult kidney transplant recipients (with at least 1 year of follow-up) on CsA and prednisone. Using logistic regression analysis, we considered the effects of pre- and postoperative variables for these complications: cataracts; new-onset posttransplant diabetes; bone/joint complications; avascular necrosis; and posttransplant hypertension. Variables included pretransplant steroid therapy; initial steroid dose; prednisone dose at 1 month and 1 year; steroid-treated rejection episodes; cumulative time on steroids; sex; age; race; pretransplant hypertension; pretransplant diabetes; donor source; nonsteroid treated rejection episodes; other immunosuppressive therapy; cumulative time on dialysis; and previous renal or extrarenal transplants. Cataracts occurred in 21.1%, new-onset posttransplant diabetes in 7.6%, bone/joint complications in 49.9%, avascular necrosis in 5.5%, and posttransplant hypertension in 74.9% of recipients. Significant variables for cataract development were prednisone dose at 1 year (odds ratio [OR] = 1.32; p<0.05), cumulative time on steroids (OR = 1.65; p<0.001), age > 50 years (OR = 1.85; p<0.0001), and pretransplant diabetes (OR = 1.63; p<0.0001). For new-onset posttransplant diabetes, age >50 years (OR = 1.63; p<0.05) and nonwhite race (OR = 2.12; p<0.001) were significant. For bone/joint complications, cumulative time on steroids was significant (OR = 1.45; p<0.001). No factors were significant for avascular necrosis. Significant variables for posttransplant hypertension were pretransplant hypertension, prednisone dose at 1 month (OR = 1.5; p<0.05), and male sex (OR = 15; p<0.01). Steroid-related complications still account for significant morbidity in CSA-treated transplant recipients. Risk factors include prednisone dose at 1 month and 1 year as well as cumulative time on steroids.