Ideal Immunosuppression After Renal Transplantation: Are Steroids Needed?

Prior to the introduction of cyclosporin in the early 1980’s, it was widely held that steroids were a necessary part of immunosuppression for successful renal transplantation. The concept of using a “low dose” prednisolone approach, reported by McGeown in 1977 (1) was slow to be accepted until controlled trial evidence was forthcoming (2). Attempts to withdraw prednisolone from long term maintenance regimes even in stable, carefully selected patients (on azathioprine) were accompanied by frequent irreversible rejection episodes (3).