Abstract:

Aim: Steroid side effects have forced the clinicans to use steroid withdrawal immunosuppressive protocols after renal transplantation. We studied the effects of steroid withdrawal immunosuppressive protocols on graft function in this prospective study. Methods: 61 renal transplant patients who have had normal graft function for the last 6 months, and who have finished their second year after transplantation were randomized either to steroid withdrawal (n=31) or steroid continued (n=30) groups. The patients were followed up for 24 months. Patients within the groups were evaiuated for their blood pressure (BP), number of acute rejection attack (ARA), fasting blood glucose, serum creatinine, trigliseride and cholestrol levels. Mean values of these parometers at 3,6,12 and 24 months were then compared with the basal mean values of the last six months before the beginning of study. For statistic alanalysis SPSS 11.0 program was used; p< 0.05 was accepted as significant. Results: In the steroid withdrawal group mean blood pressure, fasting glucose and creatinine levels were not statistically different than the pre-study basal values of the patients (p>0.05). Hence, trigliseride values were found statistically lower at each control; and cholestrollevels were also found lower at each control but statistical difference were found at the fırst three controls, within the two years (p<0.05). In the steroid-continued group non of the parameters showed statistical difference with the basal values (p<0.05). 3 attacks of acute rejections in the the steroid withdrawal group and 4 in the steroid continued group were seen (p=O. 7). One chronic allograft nephropathy in the steroid withdrawal group and 3 in the steroid continued group were seen (p=0.19). In 12 patients in the steroid withdrawal group steroid was restarted after azathiopirin toxicity, acute rejection, chronic allograft nephropathy, elevated creatinine. Conclusion: Withdrawal of steroids lowered serum lipid levels although it did not affect fasting glucose level, arterial blood pressure, and acute rejection rates. To avoid the side effects steroids in patients with stable graft functions, steroid withdrawal immunosuppressive protacols can be preferred.

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