Steroid tapering appears better than withdrawal in renal transplant recipients

באדיבות מדיקונטקסט: Last Updated: 2001-07-19 13:21:07 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) – The results of a retrospective study question the utility of complete steroid withdrawal in renal transplant recipients. Tapering steroid dosage appears to be more beneficial than complete steroid withdrawal in these patients, Dr. David Landsberg and colleagues, from St. Paul's Hospital Vancouver, in Canada, report.

In the American Journal of Kidney Diseases for June, the researchers describe the outcome of 58 renal transplant recipients, initially treated with cyclosporine, azathioprine, and prednisone, who underwent complete steroid withdrawal. The results from these subjects were compared with those from a matched control group of renal transplant recipients who were maintained on prednisone 5 mg per day or 10 mg every other day.

Tapering prednisone from 10 mg per day to 10 mg every other day led to "clinically significant improvements" in weight, blood pressure, blood pressure medications, glycosylated hemoglobin level, and diabetic medications, Dr. Landsberg and colleagues report. However, "no further benefits were seen in these parameters and total cholesterol level on complete steroid withdrawal from prednisone." Most of the early metabolic benefits associated with tapering were not sustained on long-term follow-up, they add.

Furthermore, the authors note "a modest but greater decrease in calculated creatinine clearance in the steroid-withdrawal group compared with the control group."

Dr. Landsberg and colleagues recommend, based on the results, that renal transplant recipients be maintained on prednisone 10 mg every other day or 5 mg per day as an alternative to complete steroid withdrawal.

Data from a recent Canadian multicenter trial, which suggest that steroid withdrawal may increase the risk of loss of graft function, support this recommendation, they add.

Am J Kidney Dis 2001;37:1162-1169.

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