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01-02-2009 | Review

Renal transplantation with early steroid withdrawal

Authors: Jeffrey Schiff, Edward H. Cole

Published in: Pediatric Nephrology | Issue 2/2009

Abstract

Steroids are effective immunosuppressants in renal transplantation but are associated with significant adverse effects. As a result, there has been increased interest in protocols utilizing steroid minimization. Initial trials stopped steroids at approximately 3 months, when the highest risk phase for acute rejection was over. As two randomized trials using cyclosporine and mycophenolate mofetil without induction therapy showed an unacceptably high acute rejection rate, more recent interest has focused on the cessation of steroids very early, usually within the first week after transplantation. Most protocols have used antibody induction combined with calcineurin inhibitors and mycophenolic acid derivatives. Uncontrolled studies have shown a low rate of acute rejection, but the most recent randomized controlled trials have demonstrated an increased risk of acute rejection. These trials have not shown any consistent difference in short-term patient or graft survival. Cardiovascular risk factors do not appear to be consistently improved by early steroid withdrawal. Most trials lack sufficient follow-up (5 years or more) to assess the impact of the increased acute rejection rate seen with early steroid withdrawal on long-term outcomes. Thus, the use of such protocols remains investigational.

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Title: Renal transplantation with early steroid withdrawal
Authors: Jeffrey Schiff
Edward H. Cole
Publication date: 01-02-2009
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 2/2009
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-008-0876-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Renal transplantation with early steroid withdrawal

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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