Steroid Withdrawal Based on Lymphocyte Sensitivity to Endogenous Steroid in Renal Transplant Recipients

• Takeuchi Hironori

  Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences

• Matsuno Naoto

  Department of Surgery, Center for Liver Disease, Higashi Totsuka Memorial Hospital

• Hirano Toshihiko

  Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences

• Gulimire Muhetaer

  The Fifth Department of Surgery, Hachioji Medical Center, Tokyo Medical University

• Hama Koichiro

  The Fifth Department of Surgery, Hachioji Medical Center, Tokyo Medical University

• Nakamura Yuki

  The Fifth Department of Surgery, Hachioji Medical Center, Tokyo Medical University

• Iwamoto Hitoshi

  The Fifth Department of Surgery, Hachioji Medical Center, Tokyo Medical University

• Toraishi Tatsunori

  Department of Pharmaceutics, Hachioji Medical Center, Tokyo Medical University

• Kawaguchi Takashi

  Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences

• Okuyama Kiyoshi

  Department of Pharmaceutics, Hachioji Medical Center, Tokyo Medical University

• Unezaki Sakae

  Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences

• Nagao Takeshi

  The Fifth Department of Surgery, Hachioji Medical Center, Tokyo Medical University

抄録

Though steroid withdrawal is done in many renal transplant recipients, some patients must restart steroids. Little report has investigated steroid withdrawal under pharmacodynamic monitoring. We assessed lymphocyte sensitivity to endogenous cortisol as a biomarker for determining the safety of steroid withdrawal in renal transplant patients, as we hypothesized that patients hyposensitive to cortisol could not be sufficiently immunosuppressed by their intrinsic cortisol as a substitute for the reduced or withdrawn steroid. Lymphocyte sensitivity to cortisol was examined in 30 long stable renal transplant recipients. Lymphocyte sensitivity to cortisol and its relationship with the clinical outcome after steroid reduction and withdrawal was investigated. The lymphocyte sensitivities to cortisol were estimated as IC₅₀ of lymphocyte blastogenesis. The lymphocyte proliferation rate for concentration of serum cortisol compared between incident and non-incident groups. Serum creatinine levels (S-Cr) increased in a significantly higher number of patients hyposensitive to cortisol (IC₅₀≧10000 ng/ml) than in normally sensitive patients (IC₅₀<10000 ng/ml). The incidences of steroid withdrawal syndrome and necessity for increasing steroid dose or restarting steroid administration were also higher in the patients hyposensitive to cortisol. The patients in whom the lymphocyte proliferation rate was less than 60% did not show increase in S-Cr, experience steroid withdrawal symptoms, or require an increase in the steroid dose or restart of steroid administration. The patients who have the normal IC₅₀ values of cortisol, can withdraw steroid more safely. The lymphocyte sensitivity to cortisol may be a useful biomarker for selecting patients who can sustain steroid withdrawal.

収録刊行物

• Ｂｉｏｌｏｇｉｃａｌ　＆　Ｐｈａｒｍａｃｅｕｔｉｃａｌ　Ｂｕｌｌｅｔｉｎ

  Ｂｉｏｌｏｇｉｃａｌ　＆　Ｐｈａｒｍａｃｅｕｔｉｃａｌ　Ｂｕｌｌｅｔｉｎ 34 (10), 1578-1583, 2011

  公益社団法人 日本薬学会

キーワード

• steroid withdrawal
• lymphocyte sensitivity
• endogenous cortisol
• renal transplant recipient
• biomarker

詳細情報

• CRID: 1390001204631337088
• NII論文ID: 130001086590
• NII書誌ID: AA10885497
• DOI: 10.1248/bpb.34.1578
• ISSN: 13475215
• ISSN: 09186158
• NDL書誌ID: 11250106
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I11250106
• Web Site: http://www.jstage.jst.go.jp/article/bpb/34/10/34_10_1578/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2012139289
• 本文言語コード: en
• データソース種別:
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  • NDL
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