Reduction of toxicity of corticosteroid therapy after renal transplantation

Abstract Twenty-eight patients were begun on single morning rather than divided doses of prednisone shortly after renal transplantation; in ten of these conversion to alternate-day therapy was accomplished from nine to thirty-two months after transplantation (group A), and in eighteen the conversion was completed immediately after transplantation (group B). In no patient did peptic ulcer or gastrointestinal bleeding develop. Deaths from infection occurred in two patients while receiving daily steroid therapy. Severe infections and hypertension were infrequent and controllable on single morning or alternate-day therapy, and Cushingism regressed on alternate-day therapy. Conversion to alternate-day steroid therapy was successful in nine of ten patients in group A and in fourteen of sixteen surviving patients in group B. During a total of 823 patient-months of spaced steroid therapy, despite twenty-three rejection reactions, renal function was well maintained, and no graft was irretrievably rejected. It is concluded that steroid complications can be minimized by dose-spacing without harming graft function.