Long-term alternate day steroid therapy in renal transplantation: A controlled study

Seventy-six adult renal allograft recipients were allocated 5 months post-transplantation to daily or alternate day maintenance methylprednisolone therapy. All 15 recipients of living related kidneys and 23 recipients of cadaver kidneys were placed on the alternate day regimen, while 38 patients with cadaveric grafts remained on daily methylprednisolone. In patients on alternate day methylprednisolone, serum creatinine concentrations, frequency of acute rejection episodes, and prevalence of chronic rejection were similar to those of patients on daily steroids. Furthermore, no differences were noted in the rate of loss of graft function between recipients of cadaver kidneys on daily versus alternate day steroids. There were no differences in body weight, blood pressure, degree of hyperglycemia, or hyperlipidemia between patients on the daily or alternate day schedules. However, the prevalence of clinical osteonecrosis and the rate of infectious complications requiring hospitalization were significantly decreased in patients on alternate day methylprednisolone. We conclude that alternate day methylprednisolone therapy is as effective as daily steroids for the maintenance of graft function in renal transplant recipients. The decreased incidence of osteonecrosis and the lower frequency of infectious complications represent a strong argument in favor of alternate day steroid therapy.