Effects of Cyclosporin on Prednisolone Metabolism

L, Ost

doi:10.1016/s0140-6736(84)91778-1

Cited by 81 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is some rationale to increase the dose of prednisone after withdrawing CsA. Long‐term CsA use appears to reduce the clearance of prednisone (25, 26), and the withdrawal of CsA could therefore increase clearance and reduce corticosteroid levels. However, which, if any, of the changes in the protocol for withdrawing CsA helped to reduce the incidence of postwithdrawal rejections is unclear.…”

Section: Discussionmentioning

confidence: 99%

Defining the Risk of Elective Cyclosporine Withdrawal in Stable Kidney Transplant Recipients

Anjum

Andany

McClean

et al. 2002

American Journal of Transplantation

View full text Add to dashboard Cite

Although it is known that elective cyclosporine (CsA) withdrawal increases the risk for acute rejection, few studies have been large enough to identify risk factors for acute rejection after CsA withdrawal. We examined risk factors for acute rejection in 464 kidney transplant recipients who underwent elective CsA withdrawal. The incidence of acute rejection within 6 months of CsA withdrawal was 20/141 (14.2%) in the period January 1986 to May 1989, but only 14/323 (4.5%) since May 1989 (p = 0.0002). Among those transplanted since May 1989, the incidence was 5/20 (25%) for those with both 2 HLA‐B and 2 HLA‐DR mismatches, compared with only 9/298 (3.0%) for those with fewer mismatches (p < 0.0001). In Cox proportional hazards analysis, risk factors for acute rejection within 6 months, or at any time after elective CsA withdrawal, were date of transplant January 1986 to May 1989 (compared with more recently May 1989 to March 1999), younger age, obesity, as well as B and DR mismatches. Recipient race (83% were white), acute rejection during the first year before withdrawal (31%), mycophenolate mofetil (17%), and other variables failed to predict postwithdrawal acute rejection. We concluded that avoiding CsA withdrawal in the relatively small number of recipients with both 2 HLA‐B and 2 HLA‐DR mismatches could further reduce our already low incidence of acute rejection following elective CsA withdrawal.

show abstract

Section: Discussionmentioning

confidence: 99%

Defining the Risk of Elective Cyclosporine Withdrawal in Stable Kidney Transplant Recipients

Anjum

Andany

McClean

et al. 2002

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…There is some evidence to support the notion that these side effects are dose dependent, and that lowering of steroid dose may be associated with improved insulin sensitivity [22,32]. In addition, the common combination treatment of cyclosporine A (CsA) and prednisolone is accompanied by higher serum steroid concentration than treatment with prednisolone alone, due to mutual inhibition of metabolism [33]. However, more indirect adverse effects of steroids on weight change, deposition of intra-abdominal fat and appetite [34][35][36], may also contribute to posttransplant insulin resistance.…”

Section: Glucocorticoids and Body Weightmentioning

confidence: 99%

“…Unfortunately, despite this potential beneficial effect, new-onset posttransplantation diabetes *Address correspondence to this author at the Department of Medicine, The Hospital in Vestfold HF, Boks 2168, 3103 Tønsberg, Norway; Tel: + 47 40 21 73 49; Fax: + 47 33 34 39 38; E-mail: joran@online.no mellitus (PTDM) and IGT are still commonly observed complications after renal transplantation [4][5][6][7].…”

mentioning

confidence: 99%

New-Onset Posttransplantation Diabetes Mellitus: Insulin Resistance or Insulinopenia? Impact of Immunosuppressive Drugs, Cytomegalovirus and Hepatitis C Virus Infection

Hjelmesæth¹,

Åsberg²,

Müller³

et al. 2005

CDR

View full text Add to dashboard Cite

New-onset PTDM is characterized by a variety of clinical manifestations, ranging from predominantly insulin resistance which can be handled with lifestyle intervention, to beta-cell failure requiring insulin treatment. The etiology is multi-factorial, but diabetogenic immunosuppressive drugs are of major importance. Future studies should therefore address the effects of different immunosuppressive regimens on the incidence of PTDM. In addition, the impact of cytomegalovirus infection and hepatitis C on PTDM needs further evaluation.

show abstract

“…The combination of prednisolone and CsA may also be deleterious due to mutual inhibition of metabolism (6).…”

mentioning

confidence: 99%

Insulin Resistance After Renal Transplantation

Hjelmesæth

Midtvedt²,

Jenssen³

et al. 2001

Diabetes Care

102

View full text Add to dashboard Cite

OBJECTIVE -The purpose of the present study was to validate various surrogate estimates of insulin sensitivity (IS) in a renal transplant population and to assess the influence of immunosuppressive and antihypertensive therapy on insulin resistance (IR) after renal transplantation.RESEARCH DESIGN AND METHODS -A total of 167 consecutive renal transplant recipients without previously known diabetes underwent a 75-g oral glucose tolerance test (OGTT) 3 months after renal transplantation. A total of 43 patients also underwent a euglycemichyperinsulinemic glucose clamp study. Six OGTT-derived IS indexes were validated against the euglycemic-hyperinsulinemic glucose clamp-derived IS index (ISI CLAMP ).RESULTS -The OGTT-derived ISI TX correlated closely with the ISI CLAMP (r ϭ 0.58, P Ͻ 0.001). The other surrogate estimates of IS were also significantly but less well correlated with the ISI CLAMP (Spearman's correlation; r ϭ Ϫ0.45 to 0.41, P ϭ 0.003-0.050). In the univariate model, BMI, daily prednisolone dose, creatinine clearance, hypertension, number of antihypertensive agents, and use of diuretics or ␤-blockers were negatively associated with ISI TX (P Ͻ 0.05). After multiple regression analysis, BMI (P Ͻ 0.001), daily prednisolone dose (P Ͻ 0.001), cytomegalovirus infection (P ϭ 0.030), and triglycerides (P ϭ 0.034) were shown to be independent predictors of posttransplant IR.CONCLUSIONS -The OGTT-derived ISI TX may be a useful estimate of IS in Caucasian renal transplant recipients. Increasing daily prednisolone dose is an independent predictor of IR after renal transplantation. Hypertension and the use of ␤-blockers and diuretics may also deteriorate IR in this group of patients.

show abstract

Effects of Cyclosporin on Prednisolone Metabolism

Cited by 81 publications

References 5 publications

Defining the Risk of Elective Cyclosporine Withdrawal in Stable Kidney Transplant Recipients

Defining the Risk of Elective Cyclosporine Withdrawal in Stable Kidney Transplant Recipients

New-Onset Posttransplantation Diabetes Mellitus: Insulin Resistance or Insulinopenia? Impact of Immunosuppressive Drugs, Cytomegalovirus and Hepatitis C Virus Infection

Insulin Resistance After Renal Transplantation

Contact Info

Product

Resources

About