Reversal of renal allograft rejection with intravenous methylprednisolone "pulse" therapy.

REJECTION CONTINUES TO BE A MAJOR PROBLEM confronting the transplant recipient and his surgeon. Acute reject,ion of renal allografts is commonly treated by increasing the daily oral dose of corticosteraids. Multiple complications of this therapy, including gastrointestinal hemorrhage and increased susceptibility to infection, have been reported. Intermittent large-dose intravenous corticosteroid therapy has the theoretical, but still unproved, potential of halting rejection while avoiding the toxicity associated with frequent oral administration. Intravenous corticosteroid therapy has been used by some clinicians to treat rejection [2, 41. However, many clinical transplant teams have not been convinced of the advantages of the i&ravenous route and have continued to treat relettion by increasing the oral dose of corticosteroids to 200-300 mg./day usually given in divided doses. A recent toxicologic study demonstrated that an even larger intravenous dose of