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Prednisolone is normally reduced according to the following schedule:

20 mg

  x 

1 month started on day 2

15 mg

  x

1 month

10 mg

  x

1 month

5 mg

  x

thereafter


At 3 mths to remain on minimum of 5 mg or 7.5 mg if >75 kg in weight. To remain on maintenance dose until the end of the first year and then reviewed.

At one year, cessation of Prednisolone should be considered (See steroid withdrawal protocol).See page 38.  NB caution should be exercised in patients with an “increased risk” of rejection, See page 16.


All patients to receive Ranitidine (150 mgs od) along with Prednisolone.
This schedule may be altered if rejection occurs.

* Cautions relating to Steroid withdrawal include: -

  •  
 FACs +ve
  •  
 > 2 transplants
  •  
 Panel reactive antibodies > 50% 
  •  
 Patients with intermediate risk as defined on p. 16
  •  
 Rejection episodes:1 or more acute rejection episodes  Banff grade > II
  •  
 Proteinuria
  •  
 Late acute rejection ie occurring after 6 months

Steriod withdrawal

Steroid withdrawal should be discussed with the patient and they should be informed of the increased risk of rejection.
The steroids should be withdrawn according to the following schedule:

 
Steriod induced osteoporosis

All patients should receive additional elemental calcium, this may be as one or two tablets per day depending on dietary intake.

 
Bisphosphonates

IV Pamidronate may be used in the initial post transplant period in patients with - known osteopenia or osteoporosis, a history of one or more previous transplants, 2 or more episodes of rejection (treated with high dose steroid therapy) or a history of previous disease management  with steroids.
All patients should be given advice on:

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Archive of Nov 2006 version of Prednisolone Jul 23 2009 0 kB 222

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