Long-term comparison between single-morning daily and alternate-day steroid treatment in cadaver kidney recipients

Controversy still exists in medical literature about the best type of long-term steroid regimen. On the hypothesis that the antiinflammatory effects of steroids persist longer than the undesirable metabolic effects, the administration in a single-morning dose has been proposed to reduce adrenal suppression by mimicking the endogenous circadian rhythm. However, little information is available about the optimal interval between doses. Harter suggested a 48-hr interval for prednisone, since a 24-hr interval was accompanied by adrenal suppression and a 72-hr interval was therapeutically ineffective. On the other hand, a lower level of immunosuppression was reported using delayed hypersensitivity as an index in patients on alternate-day (AD) prednisone therapy. To evaluate the effects of a single-morning daily (D) or AD dose of prednisone in cadaver kidney transplant recipients, we compared two randomized groups of patients with stable renal function during a follow-up period of up to 5 years.