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Alternate-Day Prednisone Therapy in Recipients of Renal Allografts: Risks and Benefits

Alternate-Day Prednisone Therapy in Recipients of Renal Allografts: Risks and Benefits Abstract • Forty-five patients receiving renal allografts were gradually converted from daily to alternate-day prednisone therapy. Indications for conversion included aseptic necrosis, growth retardation in children and adolescents, obesity, diabetes, cataract formation, and cosmetic appearance. Eight of the 45 patients developed acute or chronic rejection during or just after completion of alternate-day steroid therapy. The remaining 37 patients had a notable decrease in the degree of hypercorticism, with return of growth in children and adolescents. However, there was no improvement once aseptic necrosis or cataract formation had occurred. Although the use of alternate-day prednisone therapy is of benefit in reducing the untoward side effects of corticosteroids, the risk of precipitating allograft rejection is a significant threat and must be carefully considered whenever this form of treatment is undertaken. (Arch Surg 111:867-870, 1976) References 1. Starzl TE: Experience in Renal Transplantation . Philadelphia, WB Saunders Co, 1964. 2. Turcotte JG, Feduska NJ, Carpenter EW, et al: Rejection crises in human renal transplant recipients: Control with high dose methylprednisolone therapy . Arch Surg 105:230-236, 1972.Crossref 3. Harter JG, Reddy WJ, Thorn GW: Studies on an intermittant corticosteroid dosage regimen . N Engl J Med 269:591-596, 1963.Crossref 4. Reed WP, Lucas ZJ, Cohn R: Alternate day prednisone therapy after renal transplantation . Lancet 1:747-749, 1970.Crossref 5. Bell MJ, Martin LW, Gonzalez LL, et al: Alternate day single dose prednisone therapy: A method of reducing steroid toxicity . J Pediatr Surg 7:223-229, 1972.Crossref 6. Siegel RR, Luke RG, Hellebusch AA: Reduction of toxicity of corticosteroid therapy after renal transplantation . Am J Med 53:159-169, 1972.Crossref 7. McEnery PT, Gonzalez, LL, Martin LW, et al: Growth and development of children with renal transplants: Use of alternate day steroid therapy . J Pediatr 83:806-814, 1973.Crossref 8. Sampson D, Albert DJ: Alternate day therapy with methylprednisolone after renal transplantation . J Urol 109:345-348, 1973. 9. Diethelm AG, Aldrete JS, Shaw JF, et al: Clinical evaluation of equine antithymocyte globulin in recipients of renal allografts . Ann Surg 180:20-28, 1974.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Alternate-Day Prednisone Therapy in Recipients of Renal Allografts: Risks and Benefits

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Publisher
American Medical Association
Copyright
Copyright © 1976 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1976.01360260035008
Publisher site
See Article on Publisher Site

Abstract

Abstract • Forty-five patients receiving renal allografts were gradually converted from daily to alternate-day prednisone therapy. Indications for conversion included aseptic necrosis, growth retardation in children and adolescents, obesity, diabetes, cataract formation, and cosmetic appearance. Eight of the 45 patients developed acute or chronic rejection during or just after completion of alternate-day steroid therapy. The remaining 37 patients had a notable decrease in the degree of hypercorticism, with return of growth in children and adolescents. However, there was no improvement once aseptic necrosis or cataract formation had occurred. Although the use of alternate-day prednisone therapy is of benefit in reducing the untoward side effects of corticosteroids, the risk of precipitating allograft rejection is a significant threat and must be carefully considered whenever this form of treatment is undertaken. (Arch Surg 111:867-870, 1976) References 1. Starzl TE: Experience in Renal Transplantation . Philadelphia, WB Saunders Co, 1964. 2. Turcotte JG, Feduska NJ, Carpenter EW, et al: Rejection crises in human renal transplant recipients: Control with high dose methylprednisolone therapy . Arch Surg 105:230-236, 1972.Crossref 3. Harter JG, Reddy WJ, Thorn GW: Studies on an intermittant corticosteroid dosage regimen . N Engl J Med 269:591-596, 1963.Crossref 4. Reed WP, Lucas ZJ, Cohn R: Alternate day prednisone therapy after renal transplantation . Lancet 1:747-749, 1970.Crossref 5. Bell MJ, Martin LW, Gonzalez LL, et al: Alternate day single dose prednisone therapy: A method of reducing steroid toxicity . J Pediatr Surg 7:223-229, 1972.Crossref 6. Siegel RR, Luke RG, Hellebusch AA: Reduction of toxicity of corticosteroid therapy after renal transplantation . Am J Med 53:159-169, 1972.Crossref 7. McEnery PT, Gonzalez, LL, Martin LW, et al: Growth and development of children with renal transplants: Use of alternate day steroid therapy . J Pediatr 83:806-814, 1973.Crossref 8. Sampson D, Albert DJ: Alternate day therapy with methylprednisolone after renal transplantation . J Urol 109:345-348, 1973. 9. Diethelm AG, Aldrete JS, Shaw JF, et al: Clinical evaluation of equine antithymocyte globulin in recipients of renal allografts . Ann Surg 180:20-28, 1974.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1976

References