Trials and tribulations of steroid withdrawal after kidney transplantation.

The wide spectrum of morbidity associated with steroids has generated great enthusiasm in considering how they might be eliminated from immunosuppression regimens. Historically attempts to slowly wean steroids have yielded high rates of acute rejection (1,2), raising concerns for a potential increased risk of graft loss. Subsequent studies have focused on early steroid withdrawal or steroid avoidance. While many of the reports have been single center and nonrandomized, these studies have often been of large size and suggest that steroid minimization may be safe in the short term and in the correct setting (3–6). While these reports are encouraging, the issue of early steroid avoidance has not been tested with the same rigor the FDA would evaluate a new agent or new immunosuppressive regimen.