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Alternate-Day Steroid Therapy for Renal Transplant Patients

Marla Wohlman; Robert Allaben, MD; James Whitten, MD; Georgeann Edford, RN; Sidney Baskin, MD; Lawrence McNichol, MD; Luis H. Toledo-Perevra, MD, PhD
JAMA. 1981;245(24):2493-2494. doi:10.1001/jama.1981.03310490011007.
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To the Editor.—  Corticosteroids are part of the basic immunosuppressive regimen despite the number of metabolic and infectious complications associated with their prolonged use. It has long been considered that administration of twice the normal daily dose of prednisone on alternate days could minimize harmful side effects without precipitating rejection episodes in renal transplant patients.1,2 Hypoadrenalism1 and increased rejection rates3 preclude alternate-day (AD) therapy in some patients. However, it is frequently used in treating children4 because of its decreased effect on growth suppression.Recent publications indicate decreased side effects in patients on AD prednisone administration. Results are particularly favorable in patients who were previously treated with relatively high daily doses.5 In addition, results do not seem to differ between patient populations receiving living-related or cadaver kidneys.In most reports, assessment of renal function is based on the comparison of averaged creatinine clearance (GFR) or serum creatinine


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