Successful withdrawal of steroid after renal transplantation

Abstract

STEROIDS have constituted the foundation stone of immunosuppressive therapy in renal transplantation for the last four decades. In spite of the fact that the doses used can be considerably lower when cyclosporine A (CsA) is concurrently administered, steroids continue to cause a plethora of undesirable side effects and complications. Some of those unwanted effects, such as loss of bone mass or factors contributing to the development of increased risk of cardiovascular disease, remain active even at the low doses used in long term immunosuppressive therapy. For this reason, one of the planned aims of immunosuppression therapy today is to further reduce and eventually completely remove steroids. However, the benefits accruing from the cessation of steroids must be weighed against the risk of precipitating acute or chronic rejection of the allograft. The recent use of CsA in the formulation known as Neoral with its well documented pharmacokinetic advantages and, more importantly, with the significant reduction in the frequency of acute rejection in patients on mycophenolate mofetil (MMF) has brought up to the forefront again the idea of removing steroids from the long term immunosuppressive therapy scheme. We report here the results of a prospective controlled trial in which renal transplant recipients receiving Neoral, MMF, and steroids were randomly assigned to a change in their therapy which included either steroid withdrawal or alternate day steroid therapy. MATERIAL AND METHODS