For people who get a kidney transplant, steroids are a standard part of the anti-rejection drug cocktail. But they come with serious side effects, like diabetes and infections. Now a large review of 53 studies involving over 8,300 transplant recipients suggests that avoiding steroids altogether might have some real benefits.
The analysis found that people who never took steroids (steroid avoidance) were less likely to die between one and five years after transplant, and also had a lower risk of developing post-transplant diabetes. However, there was a trade-off: they faced a higher risk of acute rejection in the first year. The good news is that this rejection risk may be manageable with other powerful drugs like tacrolimus and antimetabolites.
For people who started on steroids and then stopped them (steroid withdrawal), the results were less clear. Withdrawal didn't seem to change the risk of death, rejection, or diabetes compared to staying on steroids. The evidence for both strategies was rated low to very low certainty, meaning we can't be fully confident in these findings. Many of the studies had design flaws, and only a few were blinded.
This review doesn't give a one-size-fits-all answer. It highlights that for some patients, skipping steroids might be a reasonable option, especially if they are at high risk for diabetes. But the decision should be made carefully with a doctor, weighing the potential benefits against the increased rejection risk.