HIGH DOSE INTRAVENOUS METHYLPREDNISOLONE (IVMP) VERSUS LOW DOSE ORAL PREDNISOLONE (OP) IN ACUTE RENAL ALLOGRAFT REJECTION IN CHILDREN

Abstract

Few controlled trials of different anti-rejection protocols have been published, and none in children. We report a prospective, randomised study in which two steroids regimes were compared as regards (a) effectiveness and (b) incidence and severity of side effects. Treatment A was IVMP 600 mgs/m2/dose X 3 days; treatment B was OP 3 mgs/Kg/dose X 3 days. Background immunosuppression with azathioprine was continued; pretreatment dosage of OP was resumed immediately after treatment. The diagnosis of acute rejection was made on one or more of the following: 10% rise in plasma creatinine, deterioration of renal perfusion as measured by dynamic 99mTc DTPA scan, and accepted clinical criteria. Transplant biopsy was not routinely used. Successful treatment was defined as restoration of pre-treatment values. Blood pressure, weight, and the occurrence of any ill effects attributable to the treatment were recorded. Both treatments appeared equally effective in reversing acute episodes of rejection. Toxicity was low, mainly transient fluid retention and hypertension. Treatment B avoided hospital visits and was preferred by patients; it was also very much cheaper. We found no evidence to justify continued use of IVMP.

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