CORTICOSTEROID WITHDRAWAL AFTER RENAL-TRANSPLANTATION IN THE CYCLOSPORINE ERA - TIMING, BENEFITS AND RISKS

In an effort to eliminate the well-known adverse effects of long term corticosteroid therapy, a number of transplant centres have attempted to withdraw corticosteroids at various times following renal transplan tation. Reported benefits of corticosteroid withdrawal in patients mai ntained on cyclosporin-based immunosuppressive regimens have included accelerated growth in children, improvements in hypertension, reductio ns in total cholesterol levels and improved glycaemic control for diab etic patients. However, results from single centres, and from meta-ana lyses of randomised prospective trials, suggest that corticosteroid-fr ee immunosuppression is associated with an increased risk of acute all ograft rejection when compared with treatment with corticosteroid-base d regimens. In addition, some long term follow-up studies suggest that withdrawal of corticosteroids may increase the risk of chronic allogr aft dysfunction. In the cyclosporin era, the risks of corticosteroid w ithdrawal outweigh the benefits in a substantial minority of patients, A number of new immunosuppressants may prove to be more corticosteroi d-sparing than cyclosporin, and promise to increase the safety of cort icosteroid-free immunosuppression for renal transplant recipients.