Glucocorticoid resistance in dialysis patients reduces long-term graft survival after kidney transplantation

The efficacy and safety of methylprednisolone in hepatitis B virus-related acute-on-chronic liver failure: a prospective multi-center clinical trial

“…In our multi-center, prospective randomized controlled clinical trial, sample size is much larger than others. Meanwhile, some retrospective studies have shown that the initial dose of MP (1 mg/kg/day) did not increase adverse events or mortality [34][35][36]. Therefore, in order to increase the decline of the mDCs counts and make sure the recovery of mDCs at the end of treatment, we further increased the dosage of MP treatment, with initial dosage of MP increasing to 1.5 mg/kg/day, so as to get a stronger immunosuppressive effect at the early stage and further improve the prognosis of patients.…”

“…However, MP increases the incidence of fungal infection, hypoalbuminemia, and ascites. This may be related to its activation of the renin-angiotensin system and suppression of the immune response [36].…”

Factors Contributing to Kidney Allograft Loss and Associated Consequences among Post Kidney Transplantation Patients

“…Furthermore, expected survival is significantly lower when patients return to dialysis, and re-transplantation of the patient might be hampered by new HLA-antibodies [30]. Furthermore, a study by Frezza et al [96] observed that in a long-term outcome after kidney transplantation, Glucocorticoids (GCs) resistant patients showed higher incidence of acute rejection episodes, lower acute rejection-free survival, poor response of acute rejection treatment, as well as higher incidence of renal allograft loss. However, no difference was found regarding patient mortality, wound, and vascular complications [63].…”

Steroid regulation: An overlooked aspect of tolerance and chronic rejection in kidney transplantation

“…In kidney transplant recipients, however, vitamin D levels are often low (Cianciolo et al, 2016) and a vitamin-D-induced GC resistance may be of lesser importance for them, unless high doses of exogenous vitamin D products are administered. Whist GC resistance developing during dialysis treatment prior to transplantation could also propagate into the posttransplantation period and increase the risk of CR (De Antonio et al, 2008,Frezza et al, 2014, no data were available on the pre-transplantation status of our patients as they were recruited several years post-transplantation when tolerant patients are usually identified.…”

“…GC exert their main action via the glucocorticoid receptor (GR) (NR3C1), which plays a fundamental anti-inflammatory role (Baschant and Tuckermann, 2010) and interacts via tethering with immunoregulatory transcription factors (Ratman et al, 2013). There is a clear evidence that hindered in vitro response to exogenous GC and GC resistance in dialysis patients with chronic kidney disease pre-transplantation are associated, in the long-term (Frezza et al, 2014), as well as in the short-term (De Antonio et al, 2008), with higher incidence of acute rejection and poor allograft outcomes post-transplantation. Conversely to the anti-inflammatory role of GR, a pro-inflammatory role of the MR (NR3C2) is becoming apparent (Bene et al, 2014).…”