Glucocorticoids use in kidney transplant setting.

Area of Science:

• Nephrology and Transplant Immunology
• Pharmacology and Therapeutics

Background:

• Glucocorticoids (GCs) are essential in kidney transplantation despite significant adverse events (AEs) linked to cumulative dosage.
• Understanding GCs' pharmacokinetics, pharmacodynamics, and clinical impact is crucial for optimizing transplant outcomes.
• Systemic GCs in transplant recipients necessitate a thorough review of experimental and clinical data.

Purpose of the Study:

• To provide a comprehensive overview of systemic glucocorticoids in kidney transplantation.
• To critically evaluate in vitro, pre-clinical, and clinical studies on steroid avoidance (SA) or withdrawal (SW).
• To summarize GC-related AEs, discuss minimization strategies, and highlight drug-drug interactions.

Main Methods:

• Review of in vitro and pre-clinical studies on glucocorticoids.
• Analysis of clinical studies focusing on steroid avoidance (SA) or withdrawal (SW) in kidney transplant patients.
• Summary of adverse events (AEs) and exploration of alternative management strategies.

Main Results:

• Steroid avoidance/withdrawal (SA/SW) in kidney transplant is a desirable strategy due to GC-related adverse events (AEs).
• Current evidence does not strongly support SA/SW, despite some promising reports.
• Early diagnosis and treatment of GC-induced AEs, alongside risk-factor stratification, are key strategies.

Conclusions:

• While SA/SW is theoretically beneficial for reducing GC adverse events (AEs) in kidney transplant, robust clinical evidence is currently lacking.
• Managing GC-induced AEs through early detection and treatment, and pre-transplant risk stratification, are effective approaches.
• Further randomized-controlled studies are essential to definitively assess the impact of SA/SW on short- and long-term outcomes in kidney transplant recipients.