Transplantation sans corticostéroïdes

Abstract

Used in kidney transplantation to prevent and treat rejection, corticosteroids induce a number of adverse side effects over the long term. With the arrival of new immunosuppressive drugs, trials on rapid corticosteroid interruption, a few days or weeks after transplantation, and transplantation without corticosteroids other than the intraoperative bolus, have been conducted in patients at low immunological risk and on particular patient profiles such as children and Afro-Americans. These studies show that early cessation of corticosteroids, whether in these two categories of patients or in patients at low immunological risk, make it possible to reduce the adverse side effects with no harmful influence on patient or graft survival or renal function. The increase in the rejection rate observed with this procedure has no consequences over the medium term after treatment. However, for full success, this strategy must absolutely be carried out under the cover of an induction and an immunosuppressive bitherapy. In these conditions, early interruption of corticosteroids also has beneficial effects over the longer term: it encourages the reduction in the frequency and/or severity of diabetes, weight gain, hypertension, or dyslipidemia and seems to better preserve patients'bone status.