Time of day of taking immunosuppressive agents after renal transplantation: a possible influence on graft survival

Diurnal variation in responses to influenza vaccine

Data from two field trials of influenza vaccine were examined for an association between vaccination time and subject response. Both were conducted on adults and involved the same antigens and dose via intramuscular injection. In one study (Princeton) a diurnal pattern in antibody response to the antigen A/Philippines, but not to A/Chile or B/USSR, was detected after the first vaccination administered during summer 1984, but not after the second revaccination given during summer 1985. In a second study (Houston) conducted during autumn 1985, no diurnal pattern in antibody response was detected for any of the antigens assessed. No diurnal pattern in systemic reactions was observed. Previously vaccinated subjects of both studies more commonly experienced local reactions of arm redness, hardness, and soreness after afternoon versus morning (p < 0.05) injection upon revaccination, both before and after adjustment for possible confounders of age and gender.

Influence of the time of administration of dexamethasone 0.25 mg on cortisol secretion in normal humans

Single low doses (0.25 mg) of dexamethasone were given at 11 p.m., 2, 5 and 8 a.m. on separate days to five normal subjects. The concentrations of cortisol in plasma on the next day were significantly decreased compared to results after placebo administration, and cortisol suppression was maximal after dexamethasone had been given at 8 a.m. Our findings suggests that the postulated phase-advance of circadian rhythms is not a major cause of cortisol non-suppression in depressives given dexamethasone.

Towards the Belfast immunosuppressive regimen: a prospective trial of low versus high dose steroids and once versus twice daily immunosuppression

The Transplant Unit in Belfast achieves the highest survival rates in Great Britain for renal transplants. The immunosuppression used comprises azathioprine and very low doses of steroids administered just once a day. The importance of these features has been examined in two clinical trials using (a) high or low dose steroids with azathioprine, (b) low dose steroids with azathioprine given once or twice daily following cadaveric renal transplantation. Low dose steroids were no more effective than were high dose steroids in preventing graft rejection and there was no advantage in administering immunosuppression once daily in the morning as opposed to twice daily in divided doses. None the less, with low doses of steroids the complications of cushingism and obesity were markedly reduced. Neither trial achieved the degree of success in transplant survival that has been usual in Belfast.