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World J Transplant. Apr 18, 2021; 11(4): 99-113
Published online Apr 18, 2021. doi: 10.5500/wjt.v11.i4.99
Does steroid-free immunosuppression improve the outcome in kidney transplant recipients compared to conventional protocols?
Ahmed Aref, Ajay Sharma, Ahmed Halawa
Ahmed Aref, Department of Nephrology, Sur hospital, Sur 411, Oman
Ajay Sharma, Department of Transplantation, Royal Liverpool University Hospitals, Liverpool 111, United Kingdom
Ahmed Halawa, Department of Transplantation, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
Author contributions: Halawa A selected the topics for the work, providing expert advice on our work and the final editing of the manuscript; Sharma A contributed the supervision of the scientific presentation of the data collection together with the quality evaluation of the data presented; Aref A designed the work, collected the data and wrote the manuscript.
Conflict-of-interest statement: There is no conflict of interest to be declared by any of the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed Halawa, FRCS (Gen Surg), MSc, Surgeon, Department of Transplantation, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, United Kingdom. ahmed.halawa@sth.nhs.uk
Received: November 22, 2020
Peer-review started: November 22, 2020
First decision: January 11, 2021
Revised: January 22, 2021
Accepted: March 19, 2021
Article in press: March 19, 2021
Published online: April 18, 2021
Processing time: 137 Days and 6.5 Hours
Core Tip

Core Tip: Prolonged steroid therapy was associated with many complications that ranged from cosmetic changes to life-threatening increase in cardiovascular risk profile. The utilisation of antibody induction, together with calcineurin inhibitors maintenance immune suppression, had markedly reduced the incidence of acute rejection. The improved rate of acute rejection encouraged different transplant centres to adopt new steroid-free protocols, especially in fragile cases with multiple comorbidities. Variable steroid-free approaches were tried. We aim to explore the safety and efficacy of various steroid-free protocols by comparing each different modality with the conventional triple immune suppression.