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Transplant Proc. 2004 Dec;36(10):3042-5.

Stress dose steroids in renal transplant patients undergoing lymphocele surgery.

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Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Livingston, NJ 07039-56720, USA.


The requirement for perioperative stress dose steroids (SDS) in patients on long-term steroid therapy is controversial, but SDS are given during perioperative care. Studies focusing on surrogate outcomes like cortisol levels indicate a possible requirement for SDS, but clinical results are sparse. We retrospectively compared outcomes of renal or pancreas/kidney transplant patients undergoing surgical lymphocele drainage who did (n=20) or did not (n=38) receive SDS. Patients had similar demographic characteristics (P=NS). No patient developed hypotension (SBP < 80 mmHg), mental status change, unexplained arthralgias, or ileus. Impaired wound healing occurred in one patient in each group (P=NS), and lymphocele recurrence occurred in 25% of the SDS group and 10.5% of the other group (P=.25). SBP decreased from baseline in both groups (P <.001) but did not differ between groups, and maximum blood glucose was higher in the SDS group (P=.04). No difference was observed in other measured parameters. These data indicate that SDS increased the risk of hyperglycemia and provided no apparent benefit. A prospective study is warranted to confirm these findings.

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