Prednisolone clearance in renal transplantation

Although prednisolone is the most common immunosuppressive agent used in renal transplantation, an accurate formulation of the optimal dose regimen remains to be established. A sensitive and precise radioimmunoassay was developed for this purpose. Fifty microliters of 1:20 dilutions of serum or 1:200 dilutions of urine were incubated at room temperature for two hours with 130 pg of 3H-prednisolone (150muCi/microgram) and a rabbit antiserum against prednisolone (1:1,600 dilution). Serial prednisolone clearances (Cp) for ten renal transplant patients representing variable allograft functions were compared with their corresponding creatine clearances (Cer). The data show that renal metabolism of prednisolone is well correlated with Ccr. Increasing (decreasing) Ccr is accompanied by increasing (decreasing) Cp. The availability of an assay for serum prednisolone, together with a knowledge of the ratio between these two clearances, may prove useful for regulating therapy in renal transplant patients.