Steroid-sparing regimens in organ transplantation

Although corticosteroids have been a mainstay of immunosuppressive regimens for decades, their use has been associated with significant morbidity in transplant recipients. Several studies in liver transplant recipients suggest that steroid-sparing regimens are well tolerated immunologically and may reduce cardiovascular complications associated with their use. The safety and efficacy of steroid withdrawal in kidney, pancreas, and heart transplants are less clear. With the introduction of newer, potent immunosuppressive agents such as tacrolimus, mycophenolate mofetil, and sirolimus, steroid withdrawal is being tested more frequently in these organs. Recent data in clinical pancreatic islet transplantation even suggest that corticosteroids may be contraindicated in this type of transplant. This review covers the recent progress made in steroid-sparing regimens and some of the current controversies in islet and solid organ transplantation.