High- versus Low-Dose Methylprednisolone for Acute Rejection Episodes in Renal Transplantation

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Abstract
A double-blind, randomized trial was conducted to compare the efficacy and safety of 2 doses of methylprednisolone (MP) in reversing acute rejection episodes in renal allograft recipients. Subjects (18) were randomized to receive either 250 mg (group 1) or 1000 mg (group 2) MP daily for 4 days. The 2 groups were similar with regard to HLA matching, number of cadaveric grafts, number of 2nd transplants, and transfusion history. Of 10 patients, 6 in group 1 and 4 of 8 in group 2 responded to treatment with MP, i.e., serum creatinine returned to baseline. A 1-yr follow-up has demonstrated a similar graft survival, 70% in group 1 and 50% in group 2. There were no significant differences in mortality, infectious complications, blood glucose, and blood pressure between the 2 groups. Evidently, 250 mg MP is as effective as 1000 mg in reversing acute rejection in renal allografts; 1000 mg MP does not result in a greater incidence of adverse effects, and 250 mg MP does not adversely affect 1-yr graft survival.

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