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Steroid‐free Immunosuppression in Kidney Transplantation: An Editorial Review

Corticosteroids have been a mainstay of immunosuppressive drug therapy in kidney transplantation for more than 40years. Although our understanding of the immunosuppressive mechanisms of these agents has expanded greatly during that time, dosing of corticosteroids has remained surprisingly empiric. The well-recognized adverse effects of long-term steroid therapy have led to an understandable desire to develop steroid-sparing and steroid-free immunosuppressive regimens. By increasing the risk of infection and by increasing the frequency of hypertension, hyperlipidemia and glucose intolerance, these agents undoubtedly contribute to patient mortality resulting from infectious and cardiovascular diseases. In addition, steroid-related side-effects add to the long-term cost of medical care of renal transplant recipients. One recent economic analysis considered the costs of steroid-induced hypertension, diabetes mellitus, cataracts, peripheral fractures, and aseptic necrosis of the hip in kidney transplant recipients and estimated that the cumulative 10year cost of these side-effects was $5300 per transplanted patient (1).