신이식환자에서 Prednisone과 Deflazacort의 골대사 , 면역억제능 그리고 당대사 능력의 비교에 관한 전향적 연구 - 골밀도와 면역억제능에 미치는 영향을 중심으로 -

Abstract

Kidney transplant recipients are exposed to the multiple factors that lead to the osteoporosis. The corticosteroid is mainly responsihle to the post-transplant osteoporosis. The clinical trial of deflazacort with biologically equivalent dose of conventional corticosteroid revealed less detrimental effect on the bone metabolism. We tried elective conversion from prednisone to deflazacort in recipient with stable graft function after more than post-transplant 1 year. Sixteen recipients were converted from prednisone to deflazacort as the conversion group and 20 recipients maintained on prednisone as the control group. In both groups, 2 imes of bone densitometry(BDM) test were taken at the time of study entry and susequently 1 year later respectively. There was no significant difference in terms of BDM activity in both groups. In the control group, the activity of BMD, T-score and Z-score of spine or femur neck did not change during the study period significantly. We could not find any bone sparing effect after deflazacort conversion. The biochemical markers for bone metabolism, such as serum osteocalcin, urinary deoxypyridinoline and 24hrs urinary excretion of calcium also did not improve even after deflazacort conversion. Although the body weight reduction in the conversion group was significant compared with the control group, the serum lipid profiles were not changed. The acute or chronic episodes of rejection did not occur during the study period in the conversion group. In conclusion, elective deflazacort conversion in long-term renal allograft survivors with maintenance immunosuppression has no positive impact on the bone mineral metabolism at least during the short-term follow-up.