title: Steroid withdrawal in kidney allograft recipients.
abstract: This review highlights the aggregate of knowledge obtained from the temporal trend of kidney transplant immune suppression. We will discuss the burden of steroid side effects and their impact on quality of life in kidney allograft recipients, which have led to minimizing steroid exposure. Issues arising since the inception of the concept of steroid withdrawal will be discussed, along with how they have continually led to a shift in research focus on this subject matter. The usefulness of surveillance biopsies and how further elucidation of the pathophysiology of interstitial fibrosis and tubular atrophy could contribute to improving long-term allograft outcomes will also be discussed. We will elaborate on the role of calcineurin inhibitor minimization alongside steroid withdrawal in improving long-term graft survival. Future expectations of subsequent studies with a view to improving overall kidney allograft outcomes by eliminating attendant problems associated with steroids will also be covered.
authors.affiliation: Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital, Harvard Medical School, 221 Longwood Ave, 3. Floor, Boston, MA 02115, USA.
authors.forename: Sanni
authors.initials: S
authors.lastname: Adesina
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alkhudhayri
authors.forename: Jyodi Kiran
authors.initials: JK
authors.lastname: Patel
authors.forename: Mary
authors.initials: M
authors.lastname: Naufal
authors.forename: Abdallah
authors.initials: A
authors.lastname: Geara
authors.forename: Jamil
authors.initials: J
authors.lastname: Azzi
mesh_terms: D064591:Allografts / Q000187:drug effects* / Q000276:immunology; D000818:Animals; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008991:Monitoring, Physiologic / Q000379:methods; D063868:Patient Outcome Assessment; D011788:Quality of Life; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids
keywords: acute rejection; allograft; calcineurin; cyclosporine; glomerulonephritis; immunosuppression; interstitial fibrosis and tubular atrophy; mycophenolate mofetil; new onset diabetes after transplantation; surveillance biopsy