Renal transplantation without steroids

In a randomized, controlled clinical trial, patients undergoing renal transplantation received as immunosuppression either cyclosporine alone (15 to 17 mg/kg) or cyclosporine with prednisolone, 0.3 mg/kg/d. The patients were followed up for 2 to 4 years, but no differences in the survival rates of patients or their transplants were seen. The survival of first cadaver grafts after 1 year was 73% and 76% in groups receiving cyclosporine alone and cyclosporine plus steroids, respectively. Although the patients treated with cyclosporine alone were more susceptible to nephrotoxic effects, the group receiving steroids were significantly more at risk of developing a cushingoid appearance and had an increased incidence of serious infections. After this trial, an additional 45 patients received only cyclosporine, 8 to 10 mg/kg/d, after renal transplantation. Nephrotoxic effects were much less common, and the actuarial survival rate for first cadaver grafts was 83% at 1 year. It is our view that combinations of immunosuppressive agents for kidney transplantation are both unnecessary and possibly harmful and that excellent patient and graft survival rates may be obtained with cyclosporine alone.