Immunosuppression withdrawal

During the past two decades, the emergence of new immunosuppressive drugs has provided an increasing array of possibilities for preventing acute rejection in renal transplant recipients. Because acute rejection is a major risk factor for the development of chronic allograft dysfunction, minimizing rejection is important. Furthermore, chronic allograft dysfunction ultimately leads to graft failure and return to dialysis. With the introduction of cyclosporine in 1983, the incidence of acute rejection substantially declined, and graft function during the 1st transplant year improved. Improved care for transplant recipients, better antibiotics, and a growing ability to appropriately tailor immunosuppressive regimens has led to an improved quality of life and increased longevity for transplant recipients. For this reason, minimizing the long-term side effects of the various drugs is a primary consideration. Multiple studies have investigated the withdrawal of steroids and cyclosporine, and results indicate that withdrawal is a worthwhile endeavor requiring further randomized controlled trials.