Steroid side effects and their impact on transplantation outcome

Steroids are a staple of immunosuppressive therapy in transplantation. Despite the high incidence of side effects associated with steroid therapy, the risk of increased rejection with steroid discontinuation has often outweighed the potential benefits of improved quality of life. With the advent of a number of newer immunosuppressive agents, however, there has been a renewed and heightened focus on the possibility of steroid avoidance or withdrawal protocols that do not place the patient or graft at undue risk. Much of the work in this area is preliminary, and large long-term trials are needed to reach definitive conclusions. Clinical trials need to resolve patient selection criteria for steroid discontinuation, effective and appropriate baseline immunosuppression, and the optimal timing of steroid withdrawal. Appropriate monitoring parameters also need to be developed to reduce the risk of acute rejection, and follow-up of patients who have been withdrawn from steroids will become increasingly important. Nonetheless, the hope is that newer immunosuppressive agents will soon allow for a reduction in steroid use in appropriate patients, with an improvement in patients' long-term quality of life, and fewer healthcare-related costs.