Steroid withdrawal protocols in Renal Transplantation

Corticosteroid use as a component of immunosuppression protocol is widespread, even though their mechanisms of action are imprecise. The burden of metabolic side effects of steroids and the impact on quality of life in kidney allograft recipients has led to attempts in minimizing steroid exposure. The concept of steroid withdrawal in patients requiring immunosuppression remains ill-defined without formally tested strategies balancing adverse events against good kidney allograft and patient outcomes. This review is aimed at assessing steroid withdrawal at 3 transplant centre strategies in the UK, Australia and Saudi Arabia in the light of current literature. Antibody mediated rejection, donor specific antibodies or surveillance biopsies are areas of unmet needs today that require urgent attention in this era of aggressive anti-lymphocyte or anti- cytokine induction. Use of newer induction agents such as Campath® and Simulect® are used effectively to achieve corticosteroid minimization. Since the evidence of long term patient or graft outcome reports of these corticosteroid minimization strategies is unclear, it is worth revisiting corticosteroid minimization strategies to establish evidence based practice.