ISSN:
1432-1041
Keywords:
prednisolone clearance
;
transplantation
;
renal transplant patients
;
graft rejection
;
cushingoid patients
;
side effects
;
endogenous hydrocortisone
;
adverse effect prediction
Source:
Springer Online Journal Archives 1860-2000
Topics:
Chemistry and Pharmacology
,
Medicine
Notes:
Summary The value of assessing the kinetics of prednisolone for predicting graft survival and the occurrence of adverse effects of long-term treatment with prednisolone was evaluated in 35 renal transplant patients. The subjects were given an oral test dose of 30 mg prednisolone before, shortly after and 3 months after transplantation. Serum samples were assayed for prednisolone and endogenous hydrocortisone by a specific HPLC method. Intrinsic prednisolone clearance differed less than three-fold (range 0.10–0.27 l/kg·h) between the patients and was relatively stable at different times in each of them. From the data obtained it was not possible to predict rejection episodes. If rejection occurred, however, a high clearance (≥0.20 l/kg·h) appeared to be deleterious for the outcome (p〈0.05). Patients with Cushingoid habitus did not differ from non-Cushingoid patients with respect to prednisolone clearance or endogenous hydrocortisone level. 7 out of 8 cases of steroid-related complications (steroid diabetes, psychosis, duodenal ulcer, perforation of the colon and osteonecrosis) occurred in patients with a clearance lower than 0.16 l/kg·h (ns). The one-year graft survival rate was 67% in patients with a clearance ≥0.16 l/kg·h, compared to 85% in patients with a lower clearance (ns). Although some correlation may exist between prednisolone kinetics, graft survival and steroid-related complications (not statistically significant in the present study), the predictive value of prednisolone kinetics is probably small in routine clinical work.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF00548768
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