Alternate-Day Steroid Therapy for Renal Transplant Patients-Reply

Lee A. Hebert, MD; Jacob Lemann Jr, MD; Walter Piering, MD; H. Myron Kauffman, MD
JAMA. 1981;245(24):2494. doi:10.1001/jama.1981.03310490011008.
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In Reply.—  Wohlman et al believe that maintenance-level AD steroid therapy (eg, prednisone, 25 to 30 mg every other day) is a "safe and sound" method of treatment of renal allograft recipients when renal function has stabilized after the transplant. Thus, their names, along with ours, can be added to the long list of investigators who have reported a favorable experience with most renal transplant recipients who receive AD steroid therapy. Unfortunately, despite the abundance of favorable testimony, none of us has answered the critical question: in the long-term management of the renal transplant recipient, is the risk-benefit ratio of maintenance-level AD steroid therapy substantially different from that of maintenance-level daily steroid therapy? That is, from existing data, it is not clear whether maintenancelevel AD day steroid therapy preserves renal function as well as maintenance-level daily steroid therapy, and, if it does not, is this disadvantage offset by important reductions


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