STEROID-FREE IMMUNOSUPPRESSION AFTER PENAL TRANSPLANTATION

Concerns about the side effects of chronic steroid therapy have prompt ed increasing interest in steroid-free immunosuppression for renal tra nsplant recipients who are maintained on cyclosporine-based regimens. Studies to date suggest that at least 50% of cyclosporine-treated pati ents can be managed without steroid therapy. Reported benefits of avoi ding or withdrawing steroid therapy have included improvements in hype rlipidemia, hypertension, and glucose intolerance and accelerated grow th in children. Whether these effects will increase patient or allogra ft survival remains to be proved. Furthermore, the benefits of steroid -free immunosuppression must be weighed against the risk of precipitat ing allograft rejection. Although the elimination of steroids clearly increases the short-term risk of acute rejection, further studies are needed to determine the effects of steroid-free immunosuppression on l ong-term allograft function and to identify clinical or immunologic fa ctors that can predict a successful outcome after the elimination of s teroids.