TREATMENT OF ACUTE REJECTION IN LIVE RELATED RENAL-ALLOGRAFT RECIPIENTS - A COMPARISON OF 3 DIFFERENT PROTOCOLS

We present our experience on the comparison of three different modes o f steroid therapy, oral prednisolone (OF), intravenous dexamethasone ( IVDX) and intravenous methylprednisolone (IVMP) in the treatment of ac ute rejection (AR) in renal allograft recipients. Between January 1980 and January 1992, 206 patients underwent live related renal transplan tation. Before 1990, all received prednisolone (FRED) and azathioprine (AZA) only. After 1990, patients were given PRED, AZA and cyclosporin e (CsA). After 1 year, CsA was stopped and patients were converted to a two-drug regimen only. Of the 206 patients, 180 (87.4%) were male an d mean age was 30.3 +/- 8.7 years (range 14-63). During the mean follo w-up of 43.5 months, 178 episodes of AR were seen in 121 patients. Eac h episode was considered as a separate entrant in the study. Conventio nal immunosuppression was given in 151 episodes and 27 episodes were o n triple-drug therapy. Diagnosis of AR was made by clinical, sonograph y, nuclear scan with or without graft biopsy evidence. Of the 178 AR, 110 (61.8%) were within 3 months, 36 (20.2%) were between 3 months and 1 year and 32 (18%) were after 1 year. OP was given in 11 cases while IVDX and IVMP were given in 48 and 119 cases respectively. Overall, 1 54 (86%) showed either a complete or partial response to antirejection therapy. Response to therapy was 91, 90 and 85% in OF, IVDX and IVMP groups respectively. There was no statistical difference in response r ate in different groups. There was also no difference in side effects in three different groups. Our data suggest that it is the high dose o f steroid rather than mode of therapy which is responsible for therape utic benefit in treatment of AR.