Patient death with a functioning graft is one of the major reasons for graft loss. Naturally it is our objectives to ascertain that the patient may keep his graft function until death, but renal transplant patients have an increased risk of untimely death. The major cause is of death in these patients is cardiovascular disease (CVD). Renal transplantation may reduce the risk for CVD and, conversely, side-effects of immunosuppressive drugs may increase the risk. Therefore steroid-free immunosuppression may be a beneficial alternative for many patients.
There are a number of clinical studies in renal transplantation with the objective to identify the corner stone immunosuppressive drugs that may allow for a steroid-free regimen. For example Vitko S, et al. (2005) showed that induction is necessary and that tacrolimus on its own as a maintenance regimen is not enough to protect the renal graft. Rostaing et al published in the same year (2005) a study that successfully showed that tacrolimus in combination with mycophenolate mofetil (MMF) given long-term and combined with initial daclizumab induction was similarly effective as tacrolimus/MMF given with steroids instead of induction. The incidence of post-transplant diabetes and the need for treatment of hypertension were significantly reduced in the patients given a steroid-free regimen. It is, however, important to select patients for steroid-free regimens, excluding those with an immunological high risk (Woodle, 2005).
Conclusions drawn from these studies and other recent studies such as the SYMPHONY study will be outlined including suggestions for a standard protocol of immunosuppression for normal risk patients, those appropriate to receive a steroid-free regimen, and high-risk and low-risk patients respectively.

References:
Vitko S, et al. Transplantation 2005;80(12):1734.
Rostaing L, et al. Transplantation 2005; 79: 807.
Woodle S et al. Am J Transplant 2005; 5: 2740.