Glucocorticosteroids in renal transplantation. II. Impact of high- versus low-dose postoperative methylprednisolone administration on graft survival and on the frequency and type of complications.
In a previous clinical trial we demonstrated that, by increasing the postoperative administration of methylprednisolone from 1.0 to 3.5 mg/kg/day, the onset of the first inflammatory rejection episode was significantly delayed and the size of the inflammation was reduced. The 'high initial' steroid treatment specifically depleted blast cells and macrophages from the in situ inflammatory infiltrate. In this trial we demonstrate that the 'high initial' glucocorticosteroid administration significantly improves 1-year cadaver allograft survival from 44% to 68% (P = 0.003) without increasing the number of complications. Although the 'high initial' steroid administration only partially overcomes the impact of HLA-AB incompatibility, it seems to overcome entirely the impact of absence of blood transfusions. The 'high initial' steroid administration also makes the first episodes of inflammation easier to overcome: less steroids are needed to counteract the first rejection, and, as a consequence, only 30% more steroids were used in the 'high initial' versus the 'low initial' steroid programme.
D001803:Blood Transfusion; D004305:Dose-Response Relationship, Drug; D006085:Graft Survival / Q000187:drug effects*; D006648:Histocompatibility; D006801:Humans; D016030:Kidney Transplantation; D008775:Methylprednisolone / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control
D008775:Methylprednisolone