Abstract
As a key step in setting up the immunosuppression protocols for our kidney transplantation unit, still in its infancy, consideration of the choice of the steroid withdrawal strategy is important. We conducted a review of literature to ascertain a safe steroid withdrawal protocol that would be able to achieve a high allograft survival and function rate, low acute allograft rejection (AR) rate and advantageous in reducing a wide range of adverse effects associated with corticosteroids such as cardiovascular risks, growth retardation in pediatric patients, osteoporosis and other steroid-related complications.
Highlights
Chitungwiza Central Hospital, a 500 bedded tertiary teaching hospital located in the city of Harare in the Southern African country of Zimbabwe, is at an advanced stage of establishing a kidney transplantation unit with the guidance of International Society of Nephrology
Outcomes on the basis of rabbit anti-thymocyte globin (rATG) induction with steroid withdrawal at day 4 post transplantation in African Americans maintained on TAC and Sirolimus or mycophenolate mofetil (MMF) have been analysed in two studies by Saull et al, and Haririan et al For these high immunological risk studies, the allograft rejection (AR) rates were moderate at 13-14% with a remarkably improved graft and patient survival being recorded
While the use of steroid free strategies has been applied extensively, the review has confirmed total steroid avoidance or very early withdrawal protocols as the most preferred and is considered to be effective by using lymphocyte depleting induction which reduce the immunological risk of graft failure and AR
Summary
Chitungwiza Central Hospital, a 500 bedded tertiary teaching hospital located in the city of Harare in the Southern African country of Zimbabwe, is at an advanced stage of establishing a kidney transplantation unit with the guidance of International Society of Nephrology. The recommended immunosuppression protocol includes induction by rabbit anti-thymocyte globin (rATG) and maintenance on prednisolone, tacrolimus (TAC) and mycophenolate mofetil (MMF), and does not consider steroid withdrawal. The maintenance immunosuppression includes a calcineurin inhibitor such as CsA or TAC, antiproliferative agent such as MMF or azathioprine (AZA) and a corticosteroid [1]. Steroids promote the activity of uridine diphosphate in mycophenolic acid metabolism This activity is, Citation: Moyo O, Ajay Kumar S, Halawa A (2017) Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit. Corticosteroids have been considered to inhibit T cell signals, which are responsible for apoptosis As they reduce the cytokine release, corticosteroids possibly amplify cytokine receptors expression on T Cells. By this review we aim to establish the most suitable steroid withdrawal protocol for renal transplant recipients
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