Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Obadiah Moyo, Ajay Kumar Sharma and Ahmed Halawa*

As a key step in setting up the immunosuppression protocols for our kidney transplantation unit, still in its infancy, consideration of the choice of the steroid withdrawal strategy is important. We conducted a review of literature to ascertain a safe steroid withdrawal protocol that would be able to achieve a high allograft survival and function rate, low acute allograft rejection (AR) rate and advantageous in reducing a wide range of adverse effects associated with corticosteroids such as cardiovascular risks, growth retardation in pediatric patients, osteoporosis and other steroid-related complications. 

Based on this review, steroid withdrawal was associated with high rates of AR in comparison to steroids maintenance. Specifically, late steroid withdrawal was related to poor outcomes in comparison to total steroid avoidance or very early withdrawals. High immunological risk patients with delayed graft function, prolonged cold ischemia time, donation after cardiac death, black race and those with a history of glomerulonephritis are not recommended for steroid avoidance.

Due to the unclear reduction of adverse effects and co-morbidities through steroid withdrawal or avoidance and inconclusive results and outcomes surrounding this subject which still needs further refinement, the decision taken by our unit was to retain, taper and maintain a very low dosage of corticosteroids on a long term basis with combined use of lymphocyte depleting induction agents coupled with calcineurin inhibitors and anti-proliferative agents for maintenance. Transplant recipients with low immunological risk are ideal candidates for early steroid withdrawal.

Keywords: Steroid avoidance and withdrawal; Kidney transplantation; Acute rejection; Low dose steroid maintenance; High immunological risk

Published on: Nov 15, 2017 Pages: 30-40

Full Text PDF Full Text HTML DOI: 10.17352/aot.000009
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