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Nephrol Dial Transplant (2002) 17: 19-20
© 2002 European Renal Association-European Dialysis and Transplant Association

IV.3.1 Late steroid or cyclosporine withdrawal

Guidelines

A. In order to reduce or avoid long-term serious adverse effects of corticosteroids, such as bone fractures, diabetes mellitus, arterial hypertension, osteoporosis and eye complications, steroid withdrawal should be considered.

(Evidence level B)

B. Steroid withdrawal is safe only in a proportion of graft recipients and is recommended only in low-risk patients. The efficacy of the remaining immunosuppression should be considered.

(Evidence level A)

C. After steroid withdrawal, graft function has to be monitored very carefully because of the risk of a delayed but continuous loss of function due to chronic graft dysfunction. In the case of functional deterioration or dysfunction, steroids should be re-administered.

(Evidence level C)

D. Cyclosporine withdrawal might be considered in order to ameliorate nephrotoxicity, arterial hypertension, lipid disorders and hypertrichosis. This can be carried out with no significant long-term risk of progressive graft loss. The efficacy of the remaining immunosuppression should be considered. After cyclosporine withdrawal, careful monitoring for acute rejection is recommended.

(Evidence level A)


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