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Steroid Withdrawal for the (Selected) Masses

The older literature on steroid-free immunosuppression in organ transplantation traditionally weighed the benefits of eliminating corticosteroids against the risk of precipitating acute or chronic allograft rejection (1). The recent literature has been replete with studies suggesting, with increasing credibility, that the risk of allograft rejection associated with steroid-free immunosuppression has been minimized by the use of newer antibodies for induction therapy and newer maintenance agents such mycophenolate mofetil, tacrolimus and sirolimus (2–7). With the increasing safety of steroid-free immunosuppression, a re-examination of the benefits is warranted. While the short-term advantages of eliminating corticosteroids are intuitive, it has been more difficult to determine whether avoidance or withdrawal of steroids has any positive impact on long-term outcomes.