title: Long-term study of steroid avoidance in renal transplant patients: a single-center experience.
abstract: OBJECTIVE
  Steroids have played a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with many comorbidities. This study aimed to assess the costs and benefits of a steroid-free immunosuppression regimen in a prospective randomized controlled study of living-donor renal transplantation, which was lacking in the literature.
  
  
  METHODS
  In our study, 428 patients were enrolled to receive tacrolimus (Tac), mycophenolic acid (MPA), basiliximab (Simulect, Novartis, Basel, Switzerland) induction and steroids only for 3 days (214 patients, study group) and steroid maintenance (214 patients, control group). Median follow-up was 66 ± 41 months.
  
  
  RESULTS
  We found that both groups showed comparable graft and patient survival, rejection episodes, and graft function. Posttransplantation hypertension was detected in 40% of the steroid-free group and 80% of the steroid maintenance group (P = .05), whereas posttransplantation diabetes mellitus was detected in 5% and 15% of these 2 groups, respectively (P = .3).
  
  
  CONCLUSIONS
  Among low-immunological-risk recipients of living-donor renal transplants, steroid avoidance was feasible, safe, and had less morbidity outcome using Simulect induction, then Tac and MPA as maintenance immunosuppression. Steroid avoidance was associated with a lower total cost despite comparable immunosuppression cost, which was attributed to the lower cost of associated morbidities.
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: ayman_maher2005@yahoo.com.
authors.forename: A M
authors.initials: AM
authors.lastname: Nagib
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: M H
authors.initials: MH
authors.lastname: Abbas
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: M M
authors.initials: MM
authors.lastname: Abu-Elmagd
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: A A E F
authors.initials: AA
authors.lastname: Denewar
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: A H
authors.initials: AH
authors.lastname: Neamatalla
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: A F
authors.initials: AF
authors.lastname: Refaie
authors.affiliation: Department of Dialysis and Transplantation, the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: M A
authors.initials: MA
authors.lastname: Bakr
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013256:Steroids; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids