[Transplantation without corticosteroids].

Area of Science:

• Nephrology
• Transplant Surgery
• Immunosuppression

Context:

• Corticosteroids are standard for kidney transplant rejection prevention but cause long-term adverse effects.
• New immunosuppressive drugs enable trials of rapid corticosteroid withdrawal.
• Studies focus on low immunological risk patients, children, and specific ethnic groups.

Purpose:

• To evaluate the safety and efficacy of early corticosteroid cessation in kidney transplantation.
• To assess the impact on patient and graft survival, renal function, and rejection rates.
• To determine the long-term benefits and necessary supportive immunosuppressive strategies.

Summary:

• Early corticosteroid withdrawal in kidney transplant recipients is feasible and safe, particularly in low-risk individuals and specific populations.
• While a temporary increase in rejection rates may occur, it does not compromise medium-term outcomes.
• Successful implementation requires robust induction and maintenance immunosuppression (bitherapy).

Impact:

• Reduces long-term corticosteroid-associated side effects like diabetes, weight gain, hypertension, and dyslipidemia.
• Appears to better preserve bone status in kidney transplant patients.
• Facilitates improved patient quality of life and potentially reduces overall healthcare burden.