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High- versus low-dose methylprednisolone for acute rejection episodes in renal transplantation
Abstract:
A double-blind, randomized trial was conducted to compare the efficacy and safety of two doses of methylprednisolone (MP) in reversing acute rejection episodes in renal allograft recipients. 18 subjects were randomized to receive either 250 mg (group 1) or 1,000 mg (group 2) MP daily for 4 days. The two groups were similar with regard to HLA matching, number of cadaveric grafts, number of second transplants, and transfusion history. 6 of 10 patients in group 1 and 4 of 8 in group 2 responded to treatment with MP, i.e., serum creatinine returned to baseline. 1-year follow-up has demonstrated a similar graft survival, 70% in group 1 and 50% in group 2. There were no significant differences in mortality, infectious complications, blood glucose, and blood pressure between the two groups. We conclude that (1) 250 mg MP is as effective as 1,000 mg in reversing acute rejection in renal allografts; (2) 1,000 mg MP does not result in a greater incidence of adverse effects, and (3) 250 mg MP does not adversely affect 1-year graft survival.
Insights
Lower doses of methylprednisolone (MP) effectively reverse acute renal allograft rejection. This study found 250 mg MP as effective as 1,000 mg, with similar safety and graft survival outcomes.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- Acute rejection episodes pose a significant threat to renal allograft survival.
- Methylprednisolone (MP) is a common treatment for acute rejection, but optimal dosing remains under investigation.
Purpose of the Study:
- To compare the efficacy and safety of two different doses of methylprednisolone (MP) in reversing acute rejection episodes in kidney transplant recipients.
- To evaluate the impact of different MP doses on graft survival and adverse events.
Main Methods:
- A double-blind, randomized trial involving 18 renal allograft recipients.
- Subjects were randomized to receive either 250 mg or 1,000 mg of MP daily for 4 days.
- Patient groups were comparable in terms of HLA matching, graft type, transplant history, and transfusion history.
Main Results:
- A response to MP (serum creatinine returning to baseline) was observed in 60% of patients receiving 250 mg and 50% receiving 1,000 mg.
- One-year graft survival rates were 70% for the 250 mg group and 50% for the 1,000 mg group.
- No significant differences were found between groups in mortality, infectious complications, blood glucose, or blood pressure.
Conclusions:
- 250 mg of methylprednisolone is as effective as 1,000 mg for reversing acute rejection in renal allografts.
- Higher dose methylprednisolone (1,000 mg) did not increase adverse effects or negatively impact 1-year graft survival compared to the lower dose.