Stress dose steroids in renal transplant patients undergoing lymphocele surgery

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 mm Hg), 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.