Yagisawa T, Yaguchi H, Iijima Y, Kaneko N, Watanabe M, Tomaru M, Tateno T, Izumi T, Suzuki H, Kubota Y, Nakada T
Department of Urology, Tokyo Women's Medical College.
Nihon Hinyokika Gakkai Zasshi. 1996 Sep;87(9):1127-33. doi: 10.5980/jpnjurol1989.87.1127.
The side effects of steroid are serious problems in renal transplant patients. However, withdrawal of steroid has been controversial. We evaluated the benefits and risk of early steroid withdrawal after renal transplantation.
The outcomes of early steroid withdrawal from triple immunosuppressive drug therapy were analyzed in four living related and one cadaveric renal transplant recipients. The dosage of steroid was gradually reduced and the time of steroid withdrawal after transplantation was 5 to 7.5 months.
Four Patients have been able to be free from steroid and maintained stable graft functions and normal urinary findings for 14 to 33 months after withdrawal. The findings of rejection were not observed in the graft specimens obtained by serial biopsies. One patient who received a living related graft developed an increase in serum creatinine level and proteinuria two weeks after discontinuation of steroid. The serum creatinine level returned to that before withdrawal and proteinuria disappeared by steroid readministration. Long term side effects of steroid were not observed in 4 patients with successful steroid withdrawal.
These results suggest that steroid withdrawal about 6 months after transplantation can be accomplished without jeopardizing graft function in selected renal transplant recipient and the withdrawal in the early stage is preferred for reducing the side effects. Careful and long-term follow up are required to assess the further risk and benefit of steroid withdrawal on immunosuppressive morbidity.
在肾移植患者中，类固醇的副作用是严重问题。然而，停用类固醇一直存在争议。我们评估了肾移植后早期停用类固醇的益处和风险。
分析了4例亲属活体肾移植受者和1例尸体肾移植受者在三联免疫抑制药物治疗中早期停用类固醇的结果。类固醇剂量逐渐减少，移植后停用类固醇的时间为5至7.5个月。
4例患者已能停用类固醇，停药后14至33个月移植肾功能保持稳定，尿液检查结果正常。连续活检获取的移植肾标本未观察到排斥反应表现。1例接受亲属活体肾移植的患者在停用类固醇两周后血清肌酐水平升高且出现蛋白尿。再次给予类固醇后，血清肌酐水平恢复至停药前水平，蛋白尿消失。4例成功停用类固醇的患者未观察到类固醇的长期副作用。
这些结果表明，对于部分肾移植受者，移植后约6个月停用类固醇可在不危及移植肾功能的情况下实现，且早期停用更有利于减少副作用。需要进行仔细且长期的随访，以评估停用类固醇对免疫抑制相关发病率的进一步风险和益处。
