Allograft survival in patients receiving anticonvulsant medications

The use of phenobarbital and diphenylhydantoin in transplant recipients is associated with reduced cadaver allograft survival when compared to transplant recipients not receiving anticonvulsant medication. An attempt was made to overcome the adverse effect on allograft survival by either discontinuing the anticonvulsants (2 patients) or maintaining the dose of prednisone at >1 mg/kg/day (2 patients). Discontinuation of phenobarbital was successful after transplantation, with subsequent stabilization of allograft function. Of the 2 patients receiving >1 mg/kg/day of prednisone, renal function is normal in 1 patient; however, the second is undergoing chronic rejection. Neither patient appears cushingoid. Anticonvulsant medication should be discontinued prior to transplantation. If the patient has an active seizure disorder, prednisone dosage should be maintained at a higher level.