High or low dose steroid therapy for acute renal transplant rejection after prophylactic OKT3 treatment: a prospective randomized study

Transpl Int. 1992:5 Suppl 1:S437-9. doi: 10.1007/978-3-642-77423-2_127.


In this prospective randomized study, acute renal transplant rejections occurring in patients who received prophylactic OKT3 therapy were treated with either 3 pulses of 8 mg/kg methylprednisolone (MPS) in an alternate-day regimen (total dose 25 mg/kg in 1 week, H group, n = 24) or 5 daily pulses of 3 mg/kg MPS (total dose 17 mg/kg, L group, n = 22). Acute rejection was proven by biopsy in more than 85% of cases in both groups. No difference was observed in rejection reversal (H 88%, L 91%), graft losses in the following 3 months (H 11%, L 4%) or the time evolution of the serum creatinine levels. The number (H 14, L 21) as well as the nature and severity of infections were similar in both groups. Only one death occurred in a patient who received OKT3 rescue therapy for corticoresistant rejections and developed Epstein-Barr virus (EBV)-related lymphoma. In conclusion, low dose MPS pulses appear as effective and safe as a higher dose to reverse acute rejection occurring after OKT3 prophylaxis. Thus, we favour the use of the low dose regimen in these patients.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / therapeutic use*
  • Antilymphocyte Serum / therapeutic use
  • Dose-Response Relationship, Drug
  • Graft Rejection / drug therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Infections / classification
  • Infections / epidemiology
  • Kidney Transplantation / immunology*
  • Methylprednisolone / therapeutic use*
  • Muromonab-CD3 / therapeutic use*
  • Recurrence


  • Adrenal Cortex Hormones
  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Muromonab-CD3
  • Methylprednisolone