[Steroidi tra necessità e tossicità].

Area of Science:

• Nephrology
• Transplantation Immunology
• Pharmacology

Background:

• Minimizing steroid use in immunosuppression post-renal transplant is a key goal.
• Steroid-free protocols, while reducing toxicity, historically carried a high risk of acute rejection.
• Current low-dose prednisone (5 mg/day) offers a balance but faces challenges due to interpatient variability in drug exposure.

Purpose of the Study:

• To evaluate strategies for steroid minimization in renal transplant recipients.
• To assess the efficacy and safety of different steroid withdrawal timings.
• To identify optimal immunosuppressive combinations for steroid minimization protocols.

Main Methods:

• Review of existing literature on steroid minimization and withdrawal post-renal transplantation.
• Analysis of outcomes associated with early (within 7 days) versus late (3-4 months) steroid withdrawal.
• Examination of immunosuppressive regimens, particularly Tacrolimus plus Mycophenolic Acid.

Main Results:

• Steroid-free protocols are linked to increased acute rejection but do not compromise graft survival.
• Early steroid withdrawal necessitates induction therapy, while late withdrawal may not.
• Tacrolimus combined with Mycophenolic Acid is a frequently used regimen in steroid minimization.

Conclusions:

• Steroid withdrawal remains crucial for mitigating side effects, despite the inherent risk of acute rejection.
• Both early and late steroid withdrawal strategies are viable, with specific considerations for induction therapy.
• Personalized steroid dosing is not yet available, emphasizing the importance of withdrawal strategies.