When less becomes more: Life and losses without the ‘roids’?

Despite short-term successes and a marked reduction in the overall incidence of acute rejection, long-term allograft survival after kidney transplantation has remained largely unchanged for the past three decades.1 Less than 50% of our transplant recipients have survived with a functioning graft 15 years after transplantation. The most important outcome of transplantation from the patient’s perspective is the survival of their graft.2 Strategies to improve longer-term graft outcomes remain a key priority for patients, caregivers, and health professionals. Balancing the allograft response and reducing toxicity associated with immunosuppression is essential to achieving optimal outcomes. Current immunosuppression usually includes a combination of induction therapies, such as T cell–depleting agents or IL-2 receptor antibodies, followed by a typical maintenance regimen of calcineurin inhibitors, antiproliferative agents, and corticosteroids.