Towards the Belfast immunosuppressive regimen: a prospective trial of low versus high dose steroids and once versus twice daily immunosuppression

Abstract

The Transplant Unit in Belfast achieves the highest survival rates in Great Britain for renal transplants. The immunosuppression used comprises azathioprine and very low doses of steroids administered just once a day. The importance of these features has been examined in two clinical trials using (a) high or low dose steroids with azathioprine, (b) low dose steroids with azathioprine given once or twice daily following cadaveric renal transplantation. Low dose steroids were no more effective than were high dose steroids in preventing graft rejection and there was no advantage in administering immunosuppression once daily in the morning as opposed to twice daily in divided doses. None the less, with low doses of steroids the complications of cushingism and obesity were markedly reduced. Neither trial achieved the degree of success in transplant survival that has been usual in Belfast.