Obesity Following Kidney Transplantation And Steroid Avoidance Immunosuppression

Main Category: Urology / Nephrology
Also Included In: Transplants / Organ Donations;  Obesity / Weight Loss / Fitness
Article Date: 03 May 2008 - 0:00 PDT

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UroToday.com - Over the last decade, steroid sparing immunosuppressant protocols have become widely used in renal transplantation. One of the motivating factors behind the development of steroid sparing protocols has been the desire to avoid the secondary complications of chronic steroid use. For patients, the avoidance of steroids is desirable due to the perceived risk of weight gain associated with steroid use. For transplant physicians, steroid avoidance has offered an opportunity to reduce the side effects of steroid use that include decreasing bone density, adrenal insufficiency, exacerbation of diabetes and the risks associated with increased body mass index which include hypertension, hyperlipidemia and cardiac disease. Interestingly, as immunosuppression protocols have decreased the incidence of graft loss secondary to acute rejection, patients' deaths secondary to cardiac disease has become one of the top reasons for graft loss.

We studied the amount of weight gain and change in BMI of transplant recipients that had four different immunosuppression protocols. Two of these groups did not have steroids as part of their maintenance immunosuppression. One group had prednisone weaned off at 100 days after transplantation and the final group was placed on a maintenance dose of prednisone. The results of our study indicated that there were no significant differences in weight gain among all of the treatment groups. In fact, all treatment groups gained weight post transplantation.

Although there may be some decrease in morbidity associated with steroid avoidance protocols in renal transplantation, our study indicates that effects on weight and body mass index are not significant. In attempting to reduce risks associated with obesity, alternative measures of weight control should be considered rather than steroid avoidance.

Written by David B Leeser, MD, as part of Beyond the Abstract on UroToday.com

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