How long would you continue prednisone in an ESKD patient with a failed kidney transplant who develops mild graft pain when steroids are tapered?

Typically when a patient develops pain over a failed allograft, we would try a PO pred pulse and a taper back down to 5mg daily. If, when the prednisone is low-dose or off completely, the pain recurs, you need to assess the risk/benefit for the patient of maintaining them on low dose steroid versus a transplant nephrectomy. An ultrasound and physical exam are helpful. If the ultrasound shows that the transplant is swollen and at risk of capsule rupture, the patient is having fever or hematuria and the exam is notable for a hard swollen kidney, a transplant nephrectomy is indicated. If on ultrasound and exam, there are no concerning findings, and especially if the patient is a high-risk surgical candidate, maintaining them on low-dose predni...