[Weaning from corticosteroid therapy after kidney transplantation]

For years, the numerous side effects of long term steroid administration have motivated their elimination from the immunosuppressive regimen in renal transplantation. However until the 90's, steroid withdrawal induced an increase in the incidence of acute rejection episodes, and some studies described a significant risk of graft loss. New immunosuppressive drugs (tacrolimus, mycophenolate and mTOR inhibitors) have led to reevaluate steroid discontinuation. Recent trials with these drugs have shown that late steroid withdrawal (3 months post-transplant) was no more associated with a higher risk of acute rejection or graft loss. Some studies have demonstrated an improvement in the cardiovascular risk factors and a decreased incidence of infections and osteoporosis. Its positive impact on patient survival remains to be confirmed in long term follow-up studies.