الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Corticosteroids have played a magic role in renal transplantation since more than four decades being prescribed for every patient of renal transplantation to prevent or to treat acute rejection episodes. Despite the effectiveness of Corticosteroids in improving short term graft outcome. The long term patient and subsequently graft outcome is threatened by its chronic use which is associated by increased side effects and morbidity such as hyperglycemia, hyperlipidemia and hypertension, which represent the major risk factors for development of coronary heart disease, which is considered nowadays the leading cause of death with functioning graft. Several attempts have been done for corticosteroids withdrawal several months after renal transplantation but were complicated by high rejection rate. Recently with the advent of the new era of immunosupression drugs, the danger of early rejection is minimized, hence, early steroid avoidance trials have been advocated by many transplant centers. Whilst waiting for the long-term results of well designed, well sized randomized trials comparing modern immunosuppressive regimens with or without corticosteroids, some potential advantages of avoiding these agents in renal transplant recipients should be outlined as a recommendations. i. In steroid-free patients who reject, acute rejection usually develops within the first two weeks. The diagnosis is easy and most of these rejections reverse completely after appropriate treatment. As a matter of fact, there is a bulk of evidence that early rejections are usually reversible and have a lower impact on long-term graft function than late rejections. ii. A steroid-free strategy can allow us to identify the high rejecters, who reject in the early post-transplant period, and the low rejecters, who do not show any rejection. This makes it possible to tailor the post-transplant therapy accordingly and to avoid an unnecessary vigorous immunosuppression in low-responders iii. In patients who tolerate a steroid-free immunosuppression the incidence and the severity of untoward events is low and the compliance to treatment is usually excellent. This may result in a longer survival of the patient, in a better quality of life, and in a better graft survival, noncompliance being one of the leading causes of graft loss. iv. There is another exciting, although still theoretical, reason for a steroid-free immunosuppression. As experimental studies have shown, corticosteroids can up-regulate T cell and over-express HLA antigens. Therefore any attempt to induce a tolerance in organ transplant recipients should avoid the use of corticosteroids. In summary, avoidance, or very early withdrawal of corticosteroids is today feasible in most organ transplant recipients. The few patients who need the introduction of corticosteroids, mainly due to rejection, are not exposed to an increased risk of graft dysfunction or loss. Although a number of patients may also benefit from withdrawal of corticosteroids after a few months, the risks from late rejection, progressive graft dysfunction and the development of irreversible steroid-related side effects are increased with the latter strategy