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Monitoring Stem Cell Research 
Early studies in human kidney and heart transplant recipients 
showed that MMF, when substituted for azathioprine in standard 
triple-therapy regimens, is well tolerated and more efficacious than 
azathioprine. In a large, double-blind, randomized multicenter study 
comparing MMF versus azathioprine (with CyA and prednisone) 
involving 650 patients, the MMF group was associated wnth 
significant reduction in mortality as well as a reduction in the 
requirement for rejection treatment. However, there was noted to be 
an increase in the incidence of opportunistic viral infections in the 
MMF group. The overall greater efficacy of MMF compared to 
azatliioprine has resulted in MMF generally replacing azathioprine in 
triple immunosuppressive protocols together with steroids and 
cyclosporine in most solid organ recipients. 
Corticosteroids 
Steroids are routinely used in almost all immunosuppressive 
protocols after organ transplantation. The metabolic side effects of 
steroids are well known and lead to significant morbidity and 
mortality in the post-transplant period. Almost 90% of organ 
recipients continue to receive prednisone at 1-year post-transplant 
and 70% at three-years post-transplant. A recent review of over 1800 
patients from a combined registry outlined the morbid complications 
that patients suffer within the first year after transplantation. Many 
of these complications are known side effects of prednisone, 
including hypertension (16%), diabetes mellitus (16%), hyperlipidemia 
(26%), bone disease (5%) and cataracts (2%). It is thereby obvious that 
avoidance of steroids may decrease morbidity and mortality after 
organ transplantation. Two general approaches are used to institute 
prednisone-firee immunosuppression: early and late withdrawal. 
Withdrawal of prednisone during the first month post-transplant 
has resulted in long-term success of steroid withdrawal in 50-80% of 
patients. In these studies, the use of antilymphocyte antibody 
induction therapy appears to increase the likelihood of steroid 
withdrawal. Several centers have reported their results with 
immunosuppressive regimens that did not include steroids in the 
early post-transplant period. Studies reporting high success rates of 
80% have used specific enrolment criteria, such as excluding patients 
with recurrent acute rejections or those wnth female gender. Review 
of numerous studies demonstrate that steroid free maintenance 
immunosuppression is possible in atleast 50% of patients, is as safe 
as triple drug therapy and may reduce some of the long-term 
complications of steroids. O'wing to the fact that the majority of acute 
rejection episodes occur in the first three months post-transplant. 
PRE-PUBLICATION VERSION 
