title: Clinical value of assessing prednisolone pharmacokinetics before and after renal transplantation.
abstract: The value of assessing the kinetics of prednisolone for predicting graft survival and the occurrence of adverse effects of long-term treatment with prednisolone was evaluated in 35 renal transplant patients. The subjects were given an oral test dose of 30 mg prednisolone before, shortly after and 3 months after transplantation. Serum samples were assayed for prednisolone and endogenous hydrocortisone by a specific HPLC method. Intrinsic prednisolone clearance differed less than three-fold (range 0.10-0.27 l/kg X h) between the patients and was relatively stable at different times in each of them. From the data obtained it was not possible to predict rejection episodes. If rejection occurred, however, a high clearance (greater than or equal to 0.20 l/kg X h) appeared to be deleterious for the outcome (p less than 0.05). Patients with Cushingoid habitus did not differ from non-Cushingoid patients with respect to prednisolone clearance or endogenous hydrocortisone level. 7 out of 8 cases of steroid-related complications (steroid diabetes, psychosis, duodenal ulcer, perforation of the colon and osteonecrosis) occurred in patients with a clearance lower than 0.16 l/kg X h (ns). The one-year graft survival rate was 67% in patients with a clearance greater than or equal to 0.16 l/kg X h, compared to 85% in patients with a lower clearance (ns). Although some correlation may exist between prednisolone kinetics, graft survival and steroid-related complications (not statistically significant in the present study), the predictive value of prednisolone kinetics is probably small in routine clinical work.
mesh_terms: D000328:Adult; D003480:Cushing Syndrome / Q000139:chemically induced; D005260:Female; D006084:Graft Rejection / Q000187:drug effects; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D016030:Kidney Transplantation; D007700:Kinetics; D008297:Male; D011239:Prednisolone / Q000009:adverse effects / Q000097:blood*
chemical_list: D011239:Prednisolone; D006854:Hydrocortisone