Use of steroids in renal transplantation

Abstract

LUCOCORTICOIDS (GC) have been the cornerstone of immunosuppressive therapy in organ transplantation for many years and are still used by most transplant centers for basic immunosuppression. Unfortunately, the administration of high-dose GC therapy has also represented a major cause of morbidity and mortality in transplant recipients. After the advent of cyclosporine (CyA), the doses of GC have been consistently reduced. However, steroid-related complications still account for significant morbidity in CyA-treated patients. 1 This iatrogenic morbidity in spite of the low-dose GC administration may be due to the fact that GC and CyA are metabolized by the same P-450 cytochrome system with possible retention of active metabolites of both drugs. On the other hand, the two agents may share side effects such as hypertension, diabetes, hypercholesterolemia, osteopenia, and cataracts. 2 Thus, only a steroid-free immunosuppression can actually prevent the steroid-related toxicity. Two types of steroidfree immunosuppression have been attempted in patients treated with calcineurin inhibitors: withdrawal of GC several months after transplantation in patients with stable allograft function or avoidance of GC immediately or early after transplantation.