title: Lymphocyte-depleting induction and steroid minimization after kidney transplantation: A review.
abstract: Steroid minimization after kidney transplantation has become more widely practiced as transplant clinicians seek the potential benefits such as reduced cardiovascular risk factors, improved growth in pediatric patients, and improved compliance with the immunosuppression regimen. Steroid avoidance (i.e. no steroids after the first week) is generally favored compared to later withdrawal. Induction therapy is routine in this setting, frequently rabbit antithymocyte globulin (rATG, Thymoglobulin®) or off-license use of alemtuzumab. Direct comparisons of steroid minimization regimens versus standard steroid regimens are rare. However, the available data show that the risk of acute rejection is low when rATG or alemtuzumab induction is given to support steroid-avoidance regimens after kidney transplantation. Steroid avoidance may be inadvisable in patients at high immunological risk or at risk of recurrent glomerular disease. Steroid withdrawal after day 8 may be possible without additional risk of rejection in patients given rATG induction, but while encouraging, the data are too sparse for firm conclusions. In summary, steroid avoidance may be beneficial for patients after renal transplantation, with the potential to avoid or reduce steroid-related comorbidities. Whilst depleting induction therapy could be the treatment of choice, results of prospective randomized, controlled studies are eagerly awaited.
authors.affiliation: KU Leuven - University of Leuven, Department of Microbiology and Immunology, B-3000 Leuven, Belgium; University Hospitals Leuven, Department of Nephrology, B-3000 Leuven, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: Naesens
authors.affiliation: Department of Internal Medicine, University Medical Center, Groningen, Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Berger
authors.affiliation: Department of Nephrology Dialysis and Transplantation, Ospedale Le Molinette Torino Corso, Torino, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar D'Investigacions Mediques, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Crespo
authors.affiliation: Department of Medicine, Division of Nephrology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WA, USA.
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
authors.affiliation: Department of Emergency Nephrology and Renal Transplantation, Hôpital Tenon, Sorbonne Universités, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Hertig
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Öllinger
authors.affiliation: Department of Nephrology, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Portolés
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zuckermann
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar D'Investigacions Mediques, Barcelona, Spain. Electronic address: julpascual@gmail.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
mesh_terms: D000074323:Alemtuzumab / Q000627:therapeutic use; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002318:Cardiovascular Diseases; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008212:Lymphocyte Depletion; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D013256:Steroids; D000074323:Alemtuzumab
keywords: ATG; Ahorro de esteroides; Alemtuzumab; Depleción; Depletion; Glomulina antitimocítica de conejo; Inducción; Induction; Kidney transplantation; Rabbit antithymocyte globulin; Steroid avoidance; Steroid sparing; Suspensión de esteroides; Thymoglobulin; Timoglobulina; Trasplante renal