Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Nov 18, 2021; 11(11): 443-465
Published online Nov 18, 2021. doi: 10.5500/wjt.v11.i11.443
Current status of glucocorticoid usage in solid organ transplantation
Simin Dashti-Khavidaki, Reza Saidi, Hong Lu
Simin Dashti-Khavidaki, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 14155, Iran
Reza Saidi, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Hong Lu, Department of Pharmacology, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Author contributions: Dashti-Khavidaki S and Lu H designed the report; Dashti-Khavidaki S wrote the paper; Saidi R and Lu H revised the paper.
Conflict-of-interest statement: Authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hong Lu, PhD, Assistant Professor, Department of Pharmacology, SUNY Upstate Medical University, Syracuse NY 13210, United States.
Received: May 27, 2021
Peer-review started: May 27, 2021
First decision: July 28, 2021
Revised: September 16, 2021
Accepted: November 3, 2021
Article in press: November 3, 2021
Published online: November 18, 2021

Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades, due to their potent effects on innate immunity and tissue protective effects. However, some SOT centers are reluctant to administer GCs long-term because of the various related side effects. This review summarizes the advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering “transplantation” and “glucocorticoids”. GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients, GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute antibody- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols, to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors, such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells, are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects involving different non-targeted organs/tissues, such as bone, cardiovascular, neuromuscular, skin and gastrointestinal tract, have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

Keywords: Corticosteroids, Glucocorticoids, Solid organ transplantation, Liver, Kidney, Heart, Lung

Core Tip: Due to their potent immunosuppressive and anti-inflammatory effects, glucocorticoids (GCs) are widely used in solid organ transplantation (SOT). We review the current status of GC usage in SOT, including the different clinical uses in transplant recipients and donors, new strategies for targeted organ delivery of GCs, and enhancement of immune-tolerance vs immunosuppressive effects. Major concerns about GCs, such as their adverse effects on various organs and their potential drug-drug interactions in SOT patients, are also discussed.