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Review
. 2016 Sep-Oct;36(5):469-480.
doi: 10.1016/j.nefro.2016.03.019. Epub 2016 May 14.

Lymphocyte-depleting induction and steroid minimization after kidney transplantation: A review

[Article in English, Spanish]
Maarten Naesens  1 , Stefan Berger  2 , Luigi Biancone  3 , Marta Crespo  4 , Arjang Djamali  5 , Alexandre Hertig  6 , Robert Öllinger  7 , José Portolés  8 , Andreas Zuckermann  9 , Julio Pascual  10
Affiliations
Free article
Review

Lymphocyte-depleting induction and steroid minimization after kidney transplantation: A review

[Article in English, Spanish]
Maarten Naesens et al. Nefrologia. 2016 Sep-Oct.
Free article

Abstract

Steroid minimization after kidney transplantation has become more widely practiced as transplant clinicians seek the potential benefits such as reduced cardiovascular risk factors, improved growth in pediatric patients, and improved compliance with the immunosuppression regimen. Steroid avoidance (i.e. no steroids after the first week) is generally favored compared to later withdrawal. Induction therapy is routine in this setting, frequently rabbit antithymocyte globulin (rATG, Thymoglobulin®) or off-license use of alemtuzumab. Direct comparisons of steroid minimization regimens versus standard steroid regimens are rare. However, the available data show that the risk of acute rejection is low when rATG or alemtuzumab induction is given to support steroid-avoidance regimens after kidney transplantation. Steroid avoidance may be inadvisable in patients at high immunological risk or at risk of recurrent glomerular disease. Steroid withdrawal after day 8 may be possible without additional risk of rejection in patients given rATG induction, but while encouraging, the data are too sparse for firm conclusions. In summary, steroid avoidance may be beneficial for patients after renal transplantation, with the potential to avoid or reduce steroid-related comorbidities. Whilst depleting induction therapy could be the treatment of choice, results of prospective randomized, controlled studies are eagerly awaited.

Keywords: ATG; Ahorro de esteroides; Alemtuzumab; Depleción; Depletion; Glomulina antitimocítica de conejo; Inducción; Induction; Kidney transplantation; Rabbit antithymocyte globulin; Steroid avoidance; Steroid sparing; Suspensión de esteroides; Thymoglobulin; Timoglobulina; Trasplante renal.

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