Are Maintenance Corticosteroids No Longer Necessary after Kidney Transplantation?

[摘要] Ask any group of transplant physicians or surgeons to discuss the benefits and risks of withdrawing corticosteroids after kidney transplant transplantation and you will likely hear “pro” and “con” arguments more vehement than those elicited during a discussion of politics or religion. In this issue of CJASN, Rizzari et al. (1) present yet another sequel in their amazing experience with early withdrawal of steroids from primary kidney transplant recipients at the University of Minnesota. Patients participating in this protocol all received induction therapy with rabbit antithymocyte globulin and maintenance immunosuppression with a calcineurin inhibitor and either mycophenolate mofetil or sirolimus. Each patient was subjected to rapid withdrawal of prednisone, generally by the sixth postoperative day. In a careful analysis of patient outcomes, the authors speak favorably about the safety and benefits of early steroid withdrawal with strong arguments that even the most loyal proponents of steroid-based immunosuppression may find difficult to refute.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome