Steroid Withdrawal Protocols in Renal Transplantation
Journal Title: Archives of Clinical Nephrology - Year 2018, Vol 4, Issue 1
Abstract
Corticosteroid use as a component of immunosuppression protocol is widespread, even though their mechanisms of action are imprecise. The burden of metabolic side effects of steroids and the impact on quality of life in kidney allograft recipients has led to attempts in minimizing steroid exposure. The concept of steroid withdrawal in patients requiring immunosuppression remains ill-defined without formally tested strategies balancing adverse events against good kidney allograft and patient outcomes. This review is aimed at assessing steroid withdrawal at 3 transplant centre strategies in the UK, Australia and Saudi Arabia in the light of current literature. Antibody mediated rejection, donor specific antibodies or surveillance biopsies are areas of unmet needs today that require urgent attention in this era of aggressive anti-lymphocyte or anti- cytokine induction. Use of newer induction agents such as Campath® and Simulect® are used effectively to achieve corticosteroid minimization. Since the evidence of long term patient or graft outcome reports of these corticosteroid minimization strategies is unclear, it is worth revisiting corticosteroid minimization strategies to establish evidence based practice.
Authors and Affiliations
A Banerjee, BM Julie
Keywords
Related Articles
- EP ID EP535363
- DOI 10.17352/acn.000029
- Views 68
- Downloads 0
Serum Procalcitonin Level is a Useful Predictor of Dilating Vesicoureteral Reflux in Patients with First Febrile Urinary Tract Infection
Background: Procalcitonin (PCT) has been proposed as a novel biomarker for prediction of Vesicoureteral Reflux (VUR). Since VUR is the most important risk factor for occurrence of pyelonephritis and renal tissue inflamma...
Implications of Vitamin D Deficiency in Chronic Kidney Disease - A Systematic Review
Vitamin D presents interesting pleiotropic effects for the CKD patient (effect and anti-inflammatory properties). Patients with chronic kidney disease (CKD) have impaired endothelial function and the Vitamin D and its an...
Wunderlich syndrome; Spontaneous Atraumatic Rupture of the kidney: A case report
Atraumatic spontaneous retroperitoneal haemorrhage is a distinct clinical entity with potentially life-threatening complications. The commonest aetologies include ruptured aortic or visceral aneurysm, spontaneous rupture...
Steroid Withdrawal Protocols in Renal Transplantation
Corticosteroid use as a component of immunosuppression protocol is widespread, even though their mechanisms of action are imprecise. The burden of metabolic side effects of steroids and the impact on quality of life in k...
Steroid Monotherapy for the Treatment for Pure Membranous Lupus Nephritis: A Case Series of 5 Patients and Review of the Literature
Introduction: The benefit of combination immunosuppression versus steroid monotherapy in pure membranous lupus nephritis (MLN) remains unclear. Steroid monotherapy could potentially reduce exposure to excessive immunosup...