The Toxicity of Corticosteroids

Abstract

Minimization of steroid therapy has always been one of the main objectives of immunosuppressive protocols after kidney transplantation, due to numerous side effects. The use of a further reduced daily dose of steroids is considered by many to be a fair compromise between toxicity and efficacy. Unfortunately, the great inter-individual variability of the pharmacokinetics of steroids does not prevent the appearance of major side effects in a variable percentage of patients, even with the low dose used. A drug interaction between steroids and drugs used after transplantation can also contribute to increasing daily exposure to the drug. Steroid discontinuation is still the only procedure capable of achieving the desired goal. This procedure is associated with a greater risk of acute rejection, without however reducing the survival of the transplant. It should be offered to patients at low immunological risk. Early discontinuation, during the first week of transplantation, is also the modality suggested by some guidelines, although a later suspension also offers excellent results. Induction therapy is always recommended in the case of early discontinuation.