Sep 25 2009
Stereoid Withdrawal
Steroid withdrawal implies the discontinuation of steroid administration post-transplant and needs to be differentiated from steroid avoidance, in which steroids are administered only in the event of rejection. Steroid avoidance has never been popular in the United States, although it has been applied in European countries. Many patients who avoid steroids end up receiving them for rejection anyway. Steroid withdrawal is a more tempting ploy that may be considered in select patients, although the anxiety associated with withdrawal (for both the patients and their physicians) has understandably dampened its popularity. Steroid withdrawal should be considered only in patients who are at least several months post-transplant, have not suffered recent or recurrent rejections, have excellent graft function, and are receiving relatively high doses of cyclosporine. There is some evidence that African-American transplant recipients may not be good candidates for withdrawal.
A clear-cut benefit of withdrawal, in terms of certain steroid-related side effects (bone disease, hyperlipidemia, etc) has not been demonstrated. There may be long-term deterioration in graft function in steroid withdrawn patients, who should be forewarned.