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Glucocorticosteroids in Renal Transplantation
Author(s) -
HÄYRY P.,
WILLEBRAND E.,
AHONEN J.,
EKLUND B.
Publication year - 1982
Publication title -
scandinavian journal of immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.934
H-Index - 88
eISSN - 1365-3083
pISSN - 0300-9475
DOI - 10.1111/j.1365-3083.1982.tb00697.x
Subject(s) - medicine , transplantation , kidney transplantation , inflammation , kidney , surgery , gastroenterology , urology
We have made an attempt to define a more ‘economical’ method for glucocorticosteroid (GS) administration in renal transplantation in man by shifting most of the GS to the immediate post‐operative period. Thirty cadaver kidney recipients were prerandomized in 2 groups of 15 patients and monitored by transplant aspiration cytology (TAC). After transplantation the high‐dose experimental group received 3.5 mg/kg/day of methyl‐predinisolone (MP), tapered to 0.4 mg/kg/day in 14 days, and the low‐dose control group 1.0 mg/kg/day, tapered to 0.4 mg/kg/day in 5 days. Upon rejection the patients in the high‐dose experimental group were treated with at most 7 mg/kg/day of oral MP divided into four doses daily, whereas the low‐dose control group received 1–3 intravenous boluses of 14 mg/kg (approximately 1000 mg/70 kg). Within 30 days after the transplantation, 7 clinically manifest rejection episodes and 2 episodes of in situ inflammation (without signs of rejection) were recorded in the experimental group, compared with 18 clinically manifest rejection episodes and 6 episodes of inflammation in the control group. The onset of the first episode of inflammation was delayed from 5.0±1.5 days in the control group to 6.6 ± 1.0 days (P=0.00) in the experimental group, and the onset of the first clinical rejection from 5.4±2.1 days to 8.5±1.0 days (P=0.00), respectively. TAC analysis documented that the first episode of inflammation was significantly smaller in the experimental group than in the control group (P=0.001), although the frequency of T lymphoblasts and monocytes was similar to that in the control group (P= 1.00 and 0.20), the frequency of in situ B lymphoblasts and lymphocytes was moderately depressed (P=0.04 and 0.04), and the accumulation of macrophages was both depressed (P=0.07) and delayed. After high initial MP administration the rejections were shorter and easier to overcome: the duration of the first inflammation episode was reduced from 10.5±4.4 days in the control group to 5.9±4.0 days (P=0.02) in the experimental group and the duration of clinical rejection from 8.4±4.1 days to 3.9±3.4 days, respectively (P=0.01). After 18‐month follow‐up study 12 patients in the experimental group had a life‐supporting graft, compared with 7 patients in the control group. There was no difference in the frequency or type of complications between the two groups.