The adverse effect of high dose steroids on renal autografts and homografts

We observed that canine renal homografts preserved for 5 hours with hypothermic pulsatile perfusion to which large doses of methylprednisolone were added showed obliteration of glomerular capillary loops by eosinophilic proteinaceous material immediately after revascularization. The lesion progressed to focal necrosis at 24 hours and diffuse necrosis by 5 days. Urine formation was present 7.8 (±3.2 S.D.) days in eight control kidneys not exposed to methylprednisolone, 5.8 (± 3.8 S.D.) in 11 organs perfused with 1.0 Gm. of methylprednisolone added, and 3.0 (± 2.9 S.D.) in eight with 2.0 Gm. of the drug in the standard cryoprecipitated canine plasma perfusate. Autographs treated with the larger dose also showed a similar but temporally more variable lesion. Two kidneys ceased functioning at 4 and 7 days, and six still were functioning at 14 days. Ninety four percent of human renal homografts from living related donors were functioning at one month and 82 percent at one year in 88 patients who had rejection crises treated with one gram of methylprednisolone or less intravenously. In 32 human recipients of living related donor grafts receiving 40 mg. per kilogram of methylprednisolone intravenously from days one to 3 postoperatively and for rejection crises, 69 and 59 percent were functioning at one month and one year, respectively. From this data we conclude that excessive doses of methylprednisolone are inadvisable in renal transplantation.