Date: Monday, June 3, 2019
Session Name: Poster Session C: Kidney: Acute Cellular Rejection
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Acute cellular rejection (ACR) occurs in approximately ten percent of all transplant patients and is typically treated with multiple infusions of high-dose steroids (HDS). HDS are known to increase blood glucose (BG) levels. If uncontrolled, this could lead to increased adverse events, hospitalizations, and increased medical costs. The purpose of this study is to assess effectiveness at managing hyperglycemia (HG), defined as BG>180mg/dL, in patients receiving HDS for ACR in both the inpatient and outpatient settings.
*Methods: This study is a retrospective single center chart review assessing kidney and liver transplant patients >18 years old who received HDS, defined as >500mg of methylprednisolone (MP), in response to an ACR episode from Nov 2017 through Oct 2018. Patients were excluded if they received HDS for a reason other than ACR, if they received a total MP dose <500mg, or if they had a non-intraabdominal transplant. The EMR was reviewed to assess BG levels on days following steroid infusions, changes in HG medications, admissions for HG post-HDS, and BG 7-14 days post-HDS. Primary outcome assessed was the rate of HG 7-14 days after last dose of HDS. Secondary outcomes included number of patients with HG and admissions for HG. Chi-squared was used to determine the significance of both the primary and secondary outcomes.
*Results: 31 transplant patients were included. 11 patients were treated inpatient and 20 patients were treated outpatient. There were 5 (45.5%) known diabetics in the inpatient group and 5 (25%) known diabetics in the outpatient group. 2 (18.2%) inpatients and 2 (10%) outpatients had HG 7-14 days post-HDS (p NS). Importantly, more inpatients (54.5%) than outpatients (15%) (p < 0.05) had HG medication changes for uncontrolled BG. 8 (72.7%) inpatients and 6 (30%) outpatients had HG on any day following HDS (p < 0.05). There were no admissions for HG post-HDS.
*Conclusions: HG at any point during or after HDS is frequent in both inpatient and outpatient settings. There was no statistical significance in HG 7-14 days post-HDS between the inpatient and outpatient groups; however, there were significantly more changes in HG regimens in inpatients than outpatients. These changes may have positively contributed to the rate of HG in inpatients, suggesting that closer management may improve outcomes and that guidelines for management of HG post-HDS may be helpful in both inpatients and outpatients, especially known diabetics.
To cite this abstract in AMA style:Wisniewski JL, Bruneau W, Cohen EA. Inpatient versus Outpatient Management of Hyperglycemia in Post-Transplant Patients Following High Dose Steroid Pulses for Acute Rejection [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/inpatient-versus-outpatient-management-of-hyperglycemia-in-post-transplant-patients-following-high-dose-steroid-pulses-for-acute-rejection/. Accessed April 20, 2021.
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