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That said, because prednisone was associated with a significantly lower risk of sepsis, prednisone is the top choice as an immunosuppressive steroid during renal transplantationThe study appears online August 1 in The Lancet Oncology.
Previous research has found that prednisone use may be associated with an increased risk of sepsis and other infection during kidney transplantation. For instance, a large study published in 2012 in the New England Journal of Medicine linked prednisone use and infection rates in the kidney transplant program at Columbia University Medical Center with higher rates of graft-versus-host disease and mortality. (Graft-versus-host disease is an infection that arises when one kidney rejects another during kidney transplantation.) Prior studies have also linked use of prednisone to increased rates of cancer, diabetes, and liver disease.
To examine the connection between steroid hormones and infections, researchers looked at a cohort of patients with active renal failure. Among patients enrolled in the National Kidney Foundation’s Renal Success Registry, about 35 percent developed one or more of the top 2 risk factors for infection compared with approximately 5 percent of control patients. This finding was similar in patients who developed one or more of the top 16 risk factors for infection, however, these patients were less likely to be used for kidney transplantation (12.5 percent versus 18.9 percent).
In the current study, researchers examined the incidence and mortality rates and the percentage of patients whose graft-versus-host disease developed during the second year of dialysis. They identified patients who developed a graft-versus-host disease during dialysis as those who had a risk factor that met the criteria of a risk factor with the strongest association with infection, namely, prednisone use in patients with active renal failure.
Of patients who developed one of the top 2 risk factors for infection, 45 percent were used for transplantation compared to 18.9 percent of control patients. This observation suggests that steroids may be associated with the development of both infection and graft-versus-host disease.
During dialysis patients who required steroids were more likely to develop a graft-versus-host disease compared with patients who did not receive steroids, which is similar to the situation in the case of organ transplantation. However, the difference between the 2 groups might be explained by the fact that patients who participated in the trial were more likely to develop a graft-versus-host disease during dialysis and more likely to develop a steroid-associated infection such as a cold or sinusitis, which may lead to transplantation in the early stages of kidney failure.
Researchers say that further study
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