Corticosteroids

Corticosteroids are usually used in combination with other immunosuppressive agents. Their use has decreased since the 1950s secondary to undesirable side effects. Since the 1950s, corticosteroids were used as an adjunct to irradiation for immunosuppression. Since the emergence of cyclosporin and Thymoglobulin, steroid avoidance, minimization, and withdrawal have been a common practice owing to the long list of side effects and complications. Weight gain, hyperglycemia, peptic ulcer, osteoporosis, and muscle wasting are an incomplete list of side effects associated with corticosteroid use. Weight gain has been associated with decreased ghrelin under the influence of corticosteroids, causing a decrease in metabolism. Hyperglycemia has been studied with adrenalectomized rats, showing excess corticosteroids can affect glucose metabolism by increasing hepatic glucose production and decreasing insulin sensitivity. Prior to the development of H2 antagonists, peptic ulcer was the second major complication found after transplantation. Osteoporosis is described by several mechanisms, one of which describes increasing osteoclast functioning. Adrenalectomized mice with acute diabetes showed progressive muscle wasting when given a physiologic dose of glucocorticoids. In spite of these side effects, corticosteroids when used as an adjunct to lymphocyte-depleting strategies are more efficient in preventing graft failure.