High or low dose steroid therapy for acute renal transplant rejection after prophylactic OKT3 treatment: a prospective randomized study.
In this prospective randomized study, acute renal transplant rejections occurring in patients who received prophylactic OKT3 therapy were treated with either 3 pulses of 8 mg/kg methylprednisolone (MPS) in an alternate-day regimen (total dose 25 mg/kg in 1 week, H group, n = 24) or 5 daily pulses of 3 mg/kg MPS (total dose 17 mg/kg, L group, n = 22). Acute rejection was proven by biopsy in more than 85% of cases in both groups. No difference was observed in rejection reversal (H 88%, L 91%), graft losses in the following 3 months (H 11%, L 4%) or the time evolution of the serum creatinine levels. The number (H 14, L 21) as well as the nature and severity of infections were similar in both groups. Only one death occurred in a patient who received OKT3 rescue therapy for corticoresistant rejections and developed Epstein-Barr virus (EBV)-related lymphoma. In conclusion, low dose MPS pulses appear as effective and safe as a higher dose to reverse acute rejection occurring after OKT3 prophylaxis. Thus, we favour the use of the low dose regimen in these patients.
De Backer
D
D
Department of Nephrology, CUB Hôpital Erasme, Brussels, Belgium.
Abramowicz
D
D
Goldman
M
M
De Pauw
L
L
Viseur
P
P
Vanherweghem
J L
JL
Kinnaert
P
P
Vereerstraeten
P
P
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000145:classification / Q000453:epidemiology; D016030:Kidney Transplantation / Q000276:immunology*; D008775:Methylprednisolone / Q000627:therapeutic use*; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D012008:Recurrence
D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D008775:Methylprednisolone