Steroid elimination is coming of age.

Steroid elimination is being achieved in organ transplantation. The newer generation of more powerful induction and maintenance immunosuppressants offer a new era of safe and effective steroid avoidance. The advantages of achieving independence from steroids definitely extend to the patient. Recent studies also suggest unexpected immunological benefits for the graft. Randomized studies of steroid avoidance and usage are warranted to confirm safety and efficacy, and to address pharmacokinetic and transcriptional changes as a result of steroid elimination, for optimum dosing and monitoring.