Document Detail


Low-dose maintenance prednisone and antilymphoblast globulin for the treatment of acute rejection. A steroid-sparing approach to immunosuppressive therapy.
MedLine Citation:
PMID:  6342219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 1.5 to 2.0 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.
Authors:
S B Streem; A C Novick; W E Braun; D Steinmuller; R Greenstreet
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Transplantation     Volume:  35     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1983 May 
Date Detail:
Created Date:  1983-06-17     Completed Date:  1983-06-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  420-4     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antilymphocyte Serum / administration & dosage*
Graft Rejection*
Humans
Immunosuppression*
Kidney Transplantation*
Prednisone / administration & dosage*
Chemical
Reg. No./Substance:
0/Antilymphocyte Serum; 53-03-2/Prednisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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