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Withdrawal or avoidance of glucocorticoids after renal transplantation

Brent W Miller, MD
Daniel C Brennan, MD, FACP
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD


The utility of glucocorticoids (also called corticosteroids or steroids) in transplantation was first discovered in the 1950s with experiments demonstrating the ability of these agents to enhance survival of rabbit skin grafts [1]. These observations led to the clinical use of glucocorticoids to reverse severe renal transplant rejection.

The combined administration of glucocorticoids and azathioprine was subsequently introduced as maintenance immunosuppressive therapy [2]. Significant benefits with this regimen helped transform transplantation from an experimental, infrequently used procedure to a widespread, extremely successful clinical option.

Most transplant centers administer large doses of glucocorticoids perioperatively and immediately postoperatively. This usually consists of a "pulse" intraoperative dose of 5 to 10 mg/kg of methylprednisolone, which is followed by 1 mg/kg per day of prednisone. This is subsequently tapered to approximately 0.05 to 0.1 mg/kg per day of prednisone by one year or less. (See "Maintenance immunosuppressive therapy in renal transplantation in adults".)

However, the immunosuppressive benefits derived from this glucocorticoid regimen are counterbalanced by the possible induction of numerous major adverse effects (see "Major side effects of systemic glucocorticoids"). These include the following:

Cortical bone mass quickly declines, possibly leading to osteopenia, skeletal fractures, and avascular necrosis. (See "Persistent hyperparathyroidism after renal transplantation".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 21, 2016.
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