Document Detail


Steroid-free chronic immunosuppression in renal transplantation.
MedLine Citation:
PMID:  23042028     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Over the past two decades, steroid-free immunosuppression has become more widespread, but improvements in long-term kidney transplant survival have been modest, mandating scrutiny of our chronic regimens.
RECENT FINDINGS: Current studies and commentary cautiously conclude that steroid-free regimens in low-risk patients seem acceptable for up to 5 years, although most studies are shorter. Patients who will develop chronic rejection cannot be identified prospectively and usually return to steroids. One center continues to report long-term steroid-free results that are comparable to or better than national Scientific Registry of Renal Transplant Recipients (SRTR) outcomes, even with 'older' drugs cyclosporine and azathioprine, reaffirming the need for well designed prospective studies. Some authorities question whether minimal side effects with current regimens justify steroid elimination. In low-risk populations, 'steroid-type' studies probably would suggest no short-term benefit of tacrolimus over cyclosporine, or mycophenolate over azathioprine.
SUMMARY: The data justifying steroid-free immunosuppression continue to be suboptimal. A larger question is whether to treat an entire population at medical risk or just the higher-risk subgroup that declares itself in the short term. 'Subgroup therapy' might well produce the same quandaries if applied to other accepted transplant immunosuppression.
Authors:
Robert W Steiner
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  21     ISSN:  1473-6543     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-18     Completed Date:  2013-03-29     Revised Date:  2013-05-02    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  567-73     Citation Subset:  IM    
Affiliation:
Center for Transplantation, University of California at San Diego, San Diego, California 92103-8409, USA. rsteiner@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Drug Therapy, Combination
Graft Rejection / immunology,  prevention & control*
Graft Survival / drug effects*
Humans
Immunosuppressive Agents / adverse effects,  therapeutic use*
Kidney Transplantation / adverse effects,  immunology*
Risk Factors
Steroids / adverse effects,  therapeutic use*
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 0/Steroids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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