Abstract
Corticosteroids have been the mainstay of successful immunosuppressive strategies since the early days of renal transplantation [1-3]. However, success has not come without a price; long-term use of steroids is associated with well-known metabolic and bone-related adverse effects that lead to significant long-term morbidity [4]. In addition to effects on the cardiovascular and musculoskeletal organ systems, pediatric nephrologists have also had to address concerns related to the deleterious effects of steroids on growth and possible impact on non-adherence due to their cosmetic side effects.
Highlights
Corticosteroids have been the mainstay of successful immunosuppressive strategies since the early days of renal transplantation [1,2,3]
In addition to effects on the cardiovascular and musculoskeletal organ systems, pediatric nephrologists have had to address concerns related to the deleterious effects of steroids on growth and possible impact on non-adherence due to their cosmetic side effects
Reports from other centers have confirmed the efficacy and safety of various steroid minimization or avoidance regimens in adults [6,7,8,9]. These studies have provided evidence that renal allograft recipients managed with less steroid exposure experience benefits such as a lower incidence of hypertension, diabetes, weight gain and hyperlipidemia
Summary
Corticosteroids have been the mainstay of successful immunosuppressive strategies since the early days of renal transplantation [1,2,3]. In addition to effects on the cardiovascular and musculoskeletal organ systems, pediatric nephrologists have had to address concerns related to the deleterious effects of steroids on growth and possible impact on non-adherence due to their cosmetic side effects. The feasibility of complete avoidance of steroids in adults after renal transplantation was first suggested by an open label Canadian multicenter trial [5].
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