Prednisone Avoidance After Abdominal Solid Organ Transplantation: A Narrative Review

Area of Science:

• Immunology
• Transplantation Medicine
• Clinical Pharmacology

Background:

• Long-term steroid use in solid organ transplantation causes adverse effects, impacting patient health, adherence, and healthcare costs.
• Prednisone avoidance (AoP) aims to mitigate these complications but may increase rejection risk and decrease graft survival.

Purpose of the Study:

• To review the risks and benefits of prednisone avoidance (AoP) in solid organ transplantation.
• To evaluate outcomes based on randomized studies, registry reports, and meta-analyses.

Main Methods:

• Narrative review of existing literature.
• Analysis focused on randomized controlled trials, large registry reports, and meta-analyses.
• Examination of outcomes in kidney, pancreas, and liver transplantation.

Main Results:

• In low-risk kidney recipients, AoP shows similar graft survival but may increase early rejection; steroid-resistant rejection is not elevated.
• AoP offers benefits like reduced diabetes, improved metabolic profile, bone density, and cardiovascular risk, with better growth in children.
• Data for high-risk groups and pancreas/liver transplantation are mixed or limited, suggesting feasibility in select populations.

Conclusions:

• Prednisone avoidance is a viable strategy in low-risk kidney transplant recipients, offering significant non-transplant-related benefits with comparable graft survival.
• Further large randomized trials are necessary to clarify risks and benefits in high-risk populations and other transplant types like pancreas and liver.