Effect of deflazacort versus methylprednisone on growth, body composition, lipid profile, and bone mass after renal transplantation

1432-198X

Key words Growth ; Growth factors ; Dislipoproteinemia ; Bone mineral density ; Serum leptin ; Renal transplantation ; Deflazacort

Springer Online Journal Archives 1860-2000

Medicine

Abstract  Kidney function, growth velocity, weight/ height ratio, body composition, lipid profile, and bone mass were studied in a randomized, multicenter trial of deflazacort versus methylprednisone in 27 prepubertal patients with kidney transplantation. Methylprednisone (0.20±0.03) was replaced by deflazacort (13 patients, 0.30±0.03 mg/kg per day). After 12 months, creatinine clearance decreased significantly only during methylprednisone therapy. Growth velocity increased only in patients treated with deflazacort from 3.3±0.6 to 5.6±0.5 cm/year. Serum levels of several components of the insulin-like growth factor axis did not change. Weight/height ratio was increased in methylprednisone-treated patients (P〈0.05) and decreased in deflazacort-treated patients (P〈0.005). Lean body mass increased in both groups (P〈0.005). Fat body mass and serum leptin increased only in methylprednisone-treated patients (P〈0.025). Total cholesterol and low-density lipoprotein-cholesterol increased in methylprednisone-treated patients by 9.9% (P〈0.05) and 12.5% (P〈0.025). High-density lipoprotein-cholesterol increased by 21% (P〈0.005) and apolipoprotein B decreased by 11% (P〈0.005) in deflazacort-treated patients. Total skeleton and lumbar spine bone mineral density decreased in both groups, but at 1 year methylprednisone-treated patients had lost 50% more bone. Bone mineral content decreased only in methylprednisone-treated patients (P〈0.01). Our data suggest that substituting deflazacort for maintenance methylprednisone might prevent height loss, excessive bone loss, and fat accumulation; and leads to an improvement in the lipoproteins of these children.

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