UC San Diego, San Diego, CA 92103-8409, USA.
Semin Immunopathol. 2011 Mar;33(2):157-67. doi: 10.1007/s00281-011-0259-7. Epub 2011 Feb 18.
Any evaluation of steroids in kidney transplantation is hampered by individual variability in metabolism, the lack of clinically available steroid blood levels, and overall little attention to steroid exposure. Many feel that steroids were an essential part of chronic immunosuppression in past decades but may no longer be necessary in low-risk populations when our newer and more potent drugs are used. Potential differences in long-term outcome will be unapparent in short-term antibody induction studies in low-risk patients, particularly with low on steroid doses, as may have happened in the recent, well-done Astellas trial. In many studies, the evidence for the superiority of mycophenolate (MMF) and tacrolimus (TAC) was not as strong as the evidence for the benefit of steroids in the Canadian cyclosporine study. As the practice of steroid withdrawal has increased, we have not seen the improvement in long-term graft survival that many expected with our newer agents. Steroids have immunosuppressive effects even in doses that are low by historic standards, and side effects may not justify their abandonment.
在肾移植中，类固醇的评估受到个体代谢的差异、缺乏临床可用的类固醇血药水平以及对类固醇暴露的总体关注不足的影响。许多人认为，在过去几十年中，类固醇是慢性免疫抑制的重要组成部分，但在使用我们更新、更有效的药物时，对于低风险人群来说，它们可能不再必要。在低风险患者的短期抗体诱导研究中，潜在的长期结果差异在短期内可能不明显，尤其是在低剂量使用类固醇的情况下，就像最近进行的一项精心设计的 Astellas 试验那样。在许多研究中，霉酚酸酯（MMF）和他克莫司（TAC）的优势证据并不像加拿大环孢素研究中类固醇的益处那样确凿。随着类固醇停药实践的增加，我们并没有看到许多人预期的使用新型药物对长期移植物存活率的改善。即使在历史标准下剂量较低的情况下，类固醇也具有免疫抑制作用，其副作用可能也无法证明停药是合理的。
