Current status of glucocorticoid usage in solid organ transplantation

Area of Science:

• Immunology
• Transplantation Medicine
• Pharmacology

Background:

• Glucocorticoids (GCs) are essential immunosuppressants in solid organ transplantation (SOT).
• Concerns exist regarding long-term GC side effects, prompting a re-evaluation of their use.
• GCs impact innate immunity and offer tissue protection, making them a cornerstone in SOT.

Purpose of the Study:

• To review the benefits and drawbacks of glucocorticoid use in solid organ transplantation.
• To explore novel strategies for GC application in SOT to mitigate adverse effects.

Main Methods:

• A comprehensive literature search of PubMed and Scopus databases was conducted.
• The search covered publications from 2011 to April 2021, focusing on "transplantation" and "glucocorticoids".

Main Results:

• GCs are used in recipients, donors, and perfusate to enhance SOT outcomes and manage rejections.
• Newer GC applications include budesonide, targeted delivery, and combination therapies to reduce side effects or induce tolerance.
• Significant side effects affect bone, cardiovascular, neuromuscular, skin, and gastrointestinal systems, alongside drug-drug interactions.

Conclusions:

• GCs remain critical in SOT for immunosuppression and rejection treatment.
• Balancing GC efficacy with their adverse effects is crucial, necessitating exploration of innovative delivery and combination strategies.
• Further research into novel GC applications is needed to improve long-term outcomes and patient quality of life in SOT.