ABSTRACT
Treatment with synthetic steroid hormones such as prednisolone has been used since the time of the earliest renal transplants and continues to the present day. There is no doubt as to the value of such treatment in acute cellular rejection. Its role in the prevention of rejection and the need for longterm continuation of steroid therapy has, in recent years, been called into question. Certainly, it seems possible gradually to withdraw such treatment in most patients with stable graft function some years after transplantation, without untoward deterioration in function. Over the years, it has become apparent that much lower doses of prednisone or prednisolone than were initially employed are equally satisfactory from the point of view of prevention of rejection, and much more so with respect to drug side effects. The main side effects of steroid therapy are: weight gain with mooning of the face; skin complications (including acne, development of striae and increased risk of benign and malignant skin tumours); hair loss; increased susceptibility to infections; increased risk of bleeding from duodenal ulcers; osteoporosis (thin bones); aseptic necrosis of bone, especially at the hip joint; and diabetes mellitus. From the early 1970s, a series of articles in the Lancet appeared from Northern Ireland reporting excellent results of renal transplantation in terms of graft and patient survival, employing doses of prednisolone of the order 20 mg daily from the time of the operation, tapering gradually over the succeeding months and years to a lower maintenance dose. At that time and for several years thereafter, much higher doses were employed in some centres.
