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ARTICLE |

Stability of Renal Transplant Function With Alternate-Day Corticosteroid Therapy

Richard V. Breitenfield, MD; Lee A. Hebert, MD; Jacob Lemann Jr, MD; Walter F. Piering, MD; H. Myron Kauffman, MD; Derek Sampson, MD; John Kalbfleisch, MD; Joseph A. Beres, MD
JAMA. 1980;244(2):151-156. doi:10.1001/jama.1980.03310020027021.
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Fifty-three renal transplant recipients with good to excellent renal function, while receiving daily maintenance or near-maintenance doses of azathioprine and methylprednisolone, were gradually converted to alternate-day corticosteroid therapy. Stability of allograft glomerular filtration rate (GFR) in each patient was assessed by calculating the slope of a plot of the reciprocal of the serum creatinine concentration vs time. After conversion to alternate-day therapy, GFR was stable in 80% but deteriorated in 20% of patients. However, most of the patients who experienced deteriorating GFR during alternate-day therapy regained stable renal function when given the same total corticosteroid dose but on a daily basis. This suggests but does not prove that maintenance-level daily corticosteroid therapy is better than maintenance-level alternate-day therapy in stabilizing allograft function. We conclude that maintenance-level alternate-day corticosteroid therapy should be used cautiously until a long-term prospective study determines whether there is an increased risk of losing renal function with this schedule and whether this potential risk is offset by reduced corticosteroid toxicity.

(JAMA 244:151-156, 1980)

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