Steroid withdrawal in renal transplant recipients

: The clinically important side effects of long-term steroid use are well known. We report the results of complete steroid withdrawal in 7 living-related renal transplants in HLA-identical (3) or one-haplotype match (4) recipients initially treated with azathioprine (5) or cyclosporine (2), and steroids. After the end of the second year, steroids were stopped if renal function was normal (serum creatinine below 2.0 mg/dl) and if no alterations were seen on renal biopsy. In 1 patient steroid had to be discontinued because of the complications of steroid immunosuppression. The study population consisted of 7 patients with a mean age of 32.4 years. The sex distribution was 6 males and 1 female. All patients had received a minimum of 3 blood transfusions prior to transplantation. Steroid was discontinued 34.0 +/- 18.1 months posttransplant. Oral azathioprine or cyclosporine were employed for long-term maintenance immunosuppression. Six patients (86%) have remained continuously off steroids for 52.2 +/- 50.5 months (range 4-150) with stable renal function. The mean serum creatinine was 1.1 +/- 0.4 mg/dl at the most recent follow-up. Reinstitution of steroid was required in 1 patient (14%) for rejection (36 months after steroid withdrawal). Thus, steroid withdrawal was successful in 6 of 7 patients. In HLA-identical recipients, all are currently steroid-free. In haplo-matched patients, 75% are steroid independent. Discontinuation of steroid resulted in a decrease in serum cholesterol concentration from 246 +/- 41 to 204 +/- 25 mg/dl (P less than 0.003). We conclude that steroid withdrawal may be accomplished in selected patient without increasing the rate of graft loss.(ABSTRACT TRUNCATED AT 250 WORDS)