Skip to main content

Ideal Immunosuppression After Renal Transplantation: Are Steroids Needed?

  • Chapter
International Yearbook of Nephrology 1992
  • 59 Accesses

Abstract

Prior to the introduction of cyclosporin in the early 1980’s, it was widely held that steroids were a necessary part of immunosuppression for successful renal transplantation. The concept of using a “low dose” prednisolone approach, reported by McGeown in 1977 (1) was slow to be accepted until controlled trial evidence was forthcoming (2). Attempts to withdraw prednisolone from long term maintenance regimes even in stable, carefully selected patients (on azathioprine) were accompanied by frequent irreversible rejection episodes (3).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. McGowan MG, Kennedy JA Loughridge WGG, Douglas J, Alexander JA, Clarke SD, McEvoy J Hewitt JC: One hundred transplants in Belfast City Hospital. Lancet II: 648–651 1977.

    Article  Google Scholar 

  2. D’Apice AJF, Becker GJ, Kincaid-Smith P, Mathew TH, Ng J, Hardie IR, Petrie JJB, Rigby RJ Dawborn J, Heale WF, Miarcn PJ: A prospective randomised trial of low dose versus high dose steroids in cadaveric renal transplantation. Transplantation 37: 373–377, 1984.

    Article  PubMed  Google Scholar 

  3. Lokkegaard H, Thaysen J.H.: Permanent withdrawal of prednisolone in necro-kidney transplantation Proc. EDTA 13: 216–222, 1976 (Publ. Pitman Medical).

    Google Scholar 

  4. Gray D, Shepherd H, Daar A: Oral versus intravenous high dose steroid treatment of renal allografi rejection, Lancet I: 117–118, 1978.

    Article  Google Scholar 

  5. Russ GR, May S, Jacob CK et al: Experience with cyclosporine A and azathioprine double therapy in low risk recipients of first cadaveric renal allografts. Clin Transplantation, 4: 26–32, 1990.

    Google Scholar 

  6. Stabile C, Vincenti F, Garavoy M, Duca R, Melzer J, Feduskant Salvaterra O, Amend WT: Is a “low” dose of prednisolone better than a “high” dose at the time of renal transplantation? Braz J Med Biol Res, 19: 355–366 1986.

    PubMed  CAS  Google Scholar 

  7. Fine RN: Transplantation in children. In: “Kidney Transplantation” (Ed PJ Morris), Academic Press, London, 1979, p 364.

    Google Scholar 

  8. Dumler F, Levin NW, Szego G, Bulpett AT, Prauss WE: Long term alternate day steroid therapy in renal transplantation. Transplantation, 34: 78–82, 1982.

    Article  PubMed  CAS  Google Scholar 

  9. Breitenfield FV, Hebert CA, Lemann J, Pirring WR, Kaufmann WM, Sampson D, Kalfleisch J and Beres JA: Stability of renal transplant function with alternate day corticosteroid therapy. J Am Med Assoc, 244: 157–159, 1980.

    Article  Google Scholar 

  10. Mahony JF: Long term results and complications of transplantation: the kidney. Transplantation Proc, 21: 1433, 1989.

    CAS  Google Scholar 

  11. Raine AEG, Carter R, Mann J, Chapman JR, Morris PJ: Increased plasma LDL cholesterol after renal transplantation associated with cyclosporine immunosuppression. Transplantation Proc, 19: 1820–1821, 1987.

    CAS  Google Scholar 

  12. Vathsala A, Weinberg RB, Schoenberg J, Grevel J, Dunn J, Goldstein RA, Van Buren CT, Lewis RM, Kahan BM: Lipid abnormalities in renal transplant recipients treated with cyclosporine. Transplantation Proc, 21: 3670–3673, 1989.

    CAS  Google Scholar 

  13. Bestifo AC, Petrie JJB, Rigby RJ, Hardie IR, Jacob CK, Russ GR, Mathew TH: A comparison of triple therapy with double therapy (cyclosporine/azathioprine) in low risk first cadaveric renal allograft recipients. Transplantation Proc, 21: 1604–1605, 1989.

    Google Scholar 

  14. Johnson RWG, Mallick NP, Bakran A, Pearson RC, Scott PD, Dyer P, Donaghue D, Morris D, Gokal R: Cadaver renal transplantation without maintenance steroids. Transplantation Proc, 21: 1581–1588, 1989.

    CAS  Google Scholar 

  15. Calne RY, White DJ, Thiru S, Evans DB, McMaster P, Dunn DC, Craddock GN, Pentlow BN, Rolles K: Cyclosporin A in patients receiving renal allografts from cadaver donors. Lancet, II: 1323–1327, 1978.

    Article  Google Scholar 

  16. European Multicentre Trial Group: Cyclosporine in cadaveric renal transplantations. One year following of a multicenter trial. Lancet, II: 986–989, 1983.

    Article  Google Scholar 

  17. Nott D, Griffin PJ, Salaman JR: Low dose steroids do not augment cyclosporine but do diminish cyclosporine nephrotoxicity. Transplantation Proc, 17: 1289–1290, 1985.

    Google Scholar 

  18. Hall BM, Tiller DJ, Hardie J, Mahony J, Mathew TH, Thatcher G, Miach P, Thomson N, Shiel AG: Comparison of three immunosuppressive regimes in cadaver renal transplantation, N Engl J Med, 318: 1499–1507, 1988.

    Article  PubMed  CAS  Google Scholar 

  19. Simmons RL, Canafax DM, Strand M, Ascher NL, Payne WD, Sutherland DR, Najarian JS: Management and prevention of cyclosporine nephrotoxicity after renal transplantation: Use of low doses of cyclosporine, azathioprine and prednisolone. Transplantation Proc, 17: 266–275, 1985.

    CAS  Google Scholar 

  20. Posner MP, Mendez-Picon G, King A, Nelson KP, Spicer HG, Lee HM: Is sequential low dose immunotherapy the preferred treatment in cadaveric renal transplantation. Transplantation Proc, 21: 1594–1597, 1989.

    CAS  Google Scholar 

  21. Johnson RW, Mallick NP, Bakran A, Pearson RC, Scott PD, Dyer P, Donaghue D, Morris D, Gokal R: Cadaver renal transplantation without maintenance Steroids. Transplantation Proc, 21: 1581–1582, 1989.

    CAS  Google Scholar 

  22. Margreiter R, Bosmuller C, Speilberger M, Schmid TH, Konigsrainer A: Cyclosporine monotherapy after cadaveric renal transplantation. Transplantation Proc, 21: 1591–1593, 1989.

    CAS  Google Scholar 

  23. Griffin PJA, Salaman JR: Long term results of cyclosporine monotherapy in kidney transplantation. Transplantation Proc, 23: 992–993, 1991.

    CAS  Google Scholar 

  24. Klare B, Strom TM, Hahn H, Englesberger I, Muesel E, Illner XW, Adendroth D, Land W: Remarkable long term prognosis and excellent growth in kidney transplant children under cyclosporine monotherapy. Transplantation Proc, 23: 1013–1017, 1991.

    CAS  Google Scholar 

  25. MacDonald AS, Daloze P, Dandavino R, Jundal S, Bear L, Dossetor JB, Klassen J, Stiller CR, Lockwood B, Reeve C and the Canadian Transplant Group: A randomised study of cyclosporine with and without prednisolone in renal allograft recipients. Transplantation Proc, 19: 1865–1866, 1987.

    CAS  Google Scholar 

  26. Andrew J, Campistol AJ, Oppenheimer F, Ricart MJ, Vilardele J, Talbot R, Carretero P: Improved results in elderly renal transplants without prophylatic steroids. Clin Transplantation, 5: 3–6, 1991.

    Google Scholar 

  27. Squifflet JS, Sutherland DER, Rynasiewcz JJ, Field J, Heil J, Najarían JS: Combined immunosuppressive therapy with cyclosporin A and azathioprine. Transplantation, 41: 541–544, 1986.

    Article  Google Scholar 

  28. Russ GR, May S, Jacob CK, Mathew TH, Pugsley DJ, Disney AP, Barratt LJ, Fraenkel MB, Clarkson AR, Woodroffe A: Experience with cyclosporine A and azathioprine double therapy in low risk recipients of first cadaveric renal allografts. Clin Transplantation, 4: 26–31, 1990.

    Google Scholar 

  29. Bry W, Warvarin V, Bohannon L, Feduska N, Straube B, Collins G, Levin B: Cadaveric renal transplant without prophylactic prednisolone therapy. Transplantation Proc, 23: 994–996, 1991.

    CAS  Google Scholar 

  30. Naik RB, Abdeen H, English J, Chakraborty J, Slapak M, Lee HA: Prednisolone withdrawal after 2 years in renal transplant patients receiving only this form of immunosuppression. Transplantation Proc, 11: 39–44, 1979.

    CAS  Google Scholar 

  31. Tamm M, Thiel G, Huser R, Brunner F, Hatsch M, Landmann J: Cyclosporine monotherapy after kidney transplantation since 1983. Transplantation Proc, 23: 997–998, 1991.

    CAS  Google Scholar 

  32. O’Connell PJ, D’Apice AJ, Walker RG, Francis DM, Clubie GJ, Kincaid-Smith P: Results of steroid withdrawal in renal allograft recipients in low dose cyclosporine A, azathioprine and prednisolone. Clin Transplantation, 2: 102–106, 1988.

    Google Scholar 

  33. Hariharan S, First MR, Munda R, Penn I, Schroeder TJ, Fidler J, Weiskittel P, Alexander JW: Prednisolone withdrawal in HLA identical living related donor transplant recipients. Transplantation Proc, 21: 1617–1619, 1989.

    CAS  Google Scholar 

  34. Frei D, Keusch G, Hugentobler M, Probst W, Uhlschmid G, Largiader F, Binswanger V: Withdrawal of steroids after cadaveric kidney allotransplantation on maintenance triple therapy. Transplantation Proc. 21:1620–1622, 1989.

    CAS  Google Scholar 

  35. Kupin et al: Steroid withdrawal in cyclosporine treated living related donor rental transplant recipients. Transplantation Proc, 21: 1623–1624, 1989.

    CAS  Google Scholar 

  36. Cristinelli L, Brunori G, Setti G, Manganoni A, Manganoni AM, Scolari F, Sandrini S, Scaini PS, Savoloi S, Camerini C, Maiorca R: Withdrawal of methylprednisolone on the sixth month in renal transplant recipients treated with cyclosporine. Transplantation Proc, 19: 2021–2023, 1987.

    CAS  Google Scholar 

  37. Osakabe T, Uchida H, Masaki Y, Yokota K, Sato K, Nakayama Y, Ohkubo M, Rumano K, Endo T, Watanabe K, Aso K: Studies on immunosuppression with low dose cyclosporine combined with mizoribine in experimental on clinical cadaveric renal allotransplantation. Transplantation Proc, 21: 1598–1600, 1989.

    CAS  Google Scholar 

  38. Platz KP, Eckhoff DE, Hullett DA, Gollinger HW: Prolongation of dog renal allograft survival by RS 61443 a new patient immunosuppressive agent. Transplantation Proc, 23: 497–498, 1991.

    CAS  Google Scholar 

  39. Kimball PM, Kerman RH, Kahan BO: Rapamycin and cyclosporine produce synergistic but nonidentical mechanisms of immunosuppression. Transplantation Proc, 23: 1027–1028, 1991.

    CAS  Google Scholar 

  40. Sheil AGR, Disney AP, Mathew TH, Amiss N, Excell L: Cancer development in cadaveric donor renal allograft recipients treated with azathioprine or cyclosporin or both. Transplantation Proc, 23: 111–112, 1991.

    Google Scholar 

  41. Kahana L, Narvate J, Ackerman J, Lefor W, Weinstein S, Wright C, de Quiesada A, Baxter J, Shires D: OKT3 prophylaxis versus conventional drug therapy. Single centre perspective of multicentre trial. Amer J Kidney Disease, 14: 5–9, 1989.

    CAS  Google Scholar 

  42. Morris PJ: Single or multiple therapy. Transplantation Proc, 21: 820–822, 1989.

    CAS  Google Scholar 

  43. Land W: Kidney transplantation — state of the art. Transplantation Proc, 21: 1425–1429, 1989.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1991 Springer-Verlag London Limited

About this chapter

Cite this chapter

Mathew, T.H. (1991). Ideal Immunosuppression After Renal Transplantation: Are Steroids Needed?. In: Andreucci, V.E., Fine, L.G. (eds) International Yearbook of Nephrology 1992. Springer, London. https://doi.org/10.1007/978-1-4471-1892-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-1892-3_14

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1894-7

  • Online ISBN: 978-1-4471-1892-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics