The purpose of this prospective randomized trial was to evaluate an immunosuppressive protocol involving reduced maintenance and antirejection steroid dosages in cadaver renal transplantation. The study comprises 23 first cadaver graft recipients who experienced an acute rejection episode. All patients received an initial 14-day course of antilymphocyte globulin (ALG) and azathioprine to mg/kg/day. In 11 patients (group 1), a low maintenance dose of prednisone (30 mg/day) was administered and first rejection episodes were treated with a second 10-day course of ALG. The remaining 12 patients (group 2) received high maintenance doses of prednisone (2 mg/kg/day with tapering) and intravenous methylprednisolone (IVMP) for first rejection episodes. Subsequent rejections in both groups were treated with high doses of steroids. In group 1, all first rejection episodes were reversed with ALG alone, 6 patients experienced no subsequent rejection, and 10 patients currently have a functioning graft. In Group 2, the first rejection episode was reversed with IMVP alone in 10 patients; in two patients in whom IVMP therapy was unsuccessful, ALG was then administered, and subsequent rejection reversal was effected. In group 2, 4 patients experienced no subsequent rejection, and 9 patients currently have a functioning graft. Patients in group 1 received significantly lower (P less than .01) cumulative steroid doses in the first six months following transplantation, which resulted in a reduced number of major infections, as compared with patients in group 2. We conclude that the steroid-sparing regimen of low maintenance prednisone and ALG for first rejection is as effective immunologically as the established high steroid protocol.
If you require short bursts of oral corticosteroids, you can be taken off of them by quickly decreasing the dose or at times even abruptly stopping the medications. In contrast, long term use of corticosteroids require slow, careful reduction in dosing. You may experience unpleasant side effects upon discontinuing short or long term oral corticosteroid administration. This is known as "steroid withdrawal." These adverse effects may include muscle aches, joint pains, fatigue, poor appetite, and even fever. When coming off corticosteroids, you may even be at risk for symptoms that were suppressed while on corticosteroids such as skin problems, hayfever, sinus symptoms, and arthritis-like symptoms. If you are at risk for "steroid withdrawal" symptoms, a slow taper over a long period of time may be necessary in addition to supplemental aspirin-like medication to relieve musculo-skeletal discomfort.
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