{"id":1565,"date":"2018-09-12T12:53:58","date_gmt":"2018-09-12T12:53:58","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=1565"},"modified":"2025-05-21T12:06:56","modified_gmt":"2025-05-21T12:06:56","slug":"steroid-withdrawal-or-avoidance","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/immunosuppression-protocol\/steroid-withdrawal-or-avoidance\/","title":{"rendered":"Steroid withdrawal or avoidance"},"content":{"rendered":"<p align=\"left\"><span style=\"font-family: georgia, palatino, serif;\">Patients requiring steroid sparing or avoidance protocols may include those with:<\/span><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: georgia, palatino, serif;\">history\/risk of steroid induced psychosis<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">patients at high risk of metabolic complications of steroids<\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: georgia, palatino, serif;\">Often steroid withdrawal and avoidance protocols used T-cell depleting agents as induction. Recent evidence (HARMONY\u00a0Trial) suggests that in a low risk group, the 1 year outcomes with steroid withdrawal at 7 days are excellent, using basiliximab as induction. Another RCT demonstrated double the risk of chronic allograft nephropathy at 5 years in early steroid withdrawal and a higher rate of mild rejections. Moreover, if recurrent glomerulonephritis is a concern, caution should\u00a0be urged with using a rapid steroid taper.<\/span><\/p>\n<h3><span style=\"font-size: 18pt;\"><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Steroid-sparing protocol (Based on HARMONY Trial)<\/span><\/strong><\/span><\/h3>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: georgia, palatino, serif;\">Basiliximab, tacrolimus and MMF as standard.<\/span><br \/>\n<span style=\"font-family: georgia, palatino, serif;\">The HARMONY study used 500mg prednisolone at day 0 followed by 100mg on day 1, 75mg on day 2, 50mg on day 3, and 25mg per day on days 4-7. In practice it&#8217;s generally easier to administer the day 0 steroid as IV methlyprednisolone 500mg.<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Steroids were then stopped completely at day 8.<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-size: 18pt;\"><strong><span style=\"font-family: georgia, palatino, serif; color: #993300;\">Steroid avoidance protocol<\/span><\/strong><\/span><\/h3>\n<p><span style=\"font-family: georgia, palatino, serif;\">If there was a definite history of steroid exacerbated psychosis and on risk\/balance avoidance of steroid was felt to be paramount. Most complete steroid avoidance\u00a0regimes in the literature have employed T-cell depleting agents for induction.<\/span><\/p>\n<ul style=\"list-style-type: disc;\">\n<li><span style=\"font-family: georgia, palatino, serif;\">ATG or Alemtuzumab (Campath) for induction &#8211; as per immunosuppression section. We generally use ATG as our T-cell depleting agent of choice.<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Despite being called steroid avoidance, these have protocols generally used IV methylprednisolone prior to ATG\/Alemtuzumab (Campath) on day 0 and 1. If absolute steroid avoidance is necessary, this should be agreed with a consultant psychiatrist and an individulised regime devised for that patient, weighing up risks of using\/not-using any steroid.<\/span><\/li>\n<li><span style=\"font-family: georgia, palatino, serif;\">Ensure tacrolimus level of 10-12 early on.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patients requiring steroid sparing or avoidance protocols may include those with: history\/risk of steroid induced psychosis patients at high risk of metabolic complications of steroids Often steroid withdrawal and avoidance protocols used T-cell depleting agents as induction. Recent evidence (HARMONY\u00a0Trial) suggests that in a low risk group, the 1 year\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/immunosuppression-protocol\/steroid-withdrawal-or-avoidance\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1550,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-1565","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1565","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=1565"}],"version-history":[{"count":9,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1565\/revisions"}],"predecessor-version":[{"id":6644,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1565\/revisions\/6644"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1550"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=1565"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}