Renal transplantation without steroids

Cyclosporin has been in use in our unit since 1982 to treat renal transplant recipients. In two controlled clinical trials cyclosporin monotherapy was compared with cyclosporin with steroids, and with cyclosporin with azathioprine. The addition of steroids did not improve graft survival but did increase the incidence of infection. The addition of azathioprine also had no effect upon graft outcome. We conclude that cyclosporin monotherapy provides very adequate immunosuppression in the majority of cases giving an 80% survival rate for cadaveric kidney transplants at 1 year. Triple therapy has been used successfully by other centres although graft survival rates are no different from our own. Such treatment does, however, provide more powerful immunosuppression and is appropriate for previously sensitised patients and for children. Under this regimen steroids can be withdrawn at a later date. Sequential therapy with four agents is highly immunosuppressive. The long-term results are uncertain at the present time, and this expensive treatment needs careful evaluation. In our experience it is perfectly possible to undertake cadaveric renal transplantation without having to prescribe regular steroid therapy for the majority of patients. We have been impressed by the lack of serious side effects with this treatment and would still regard cyclosporin monotherapy as the treatment of choice for unsensitised renal transplant patients.