How are glucocorticoids used to prevent or treat transplant rejection?

Glucocorticoids, such as cortisone, prednisone, and prednisolone, are essential immunosuppressant agents used in transplant surgery to prevent and treat organ graft rejection. They function by inhibiting the immune system, which helps prevent the body from attacking the transplanted organ.123

These drugs are typically administered in combination with other immunosuppressive agents, such as calcineurin inhibitors (e.g., cyclosporine) or antiproliferative drugs like sirolimus and mycophenolate mofetil. While they are used for long-term prevention, they are particularly critical during an active rejection crisis.21

Despite their efficacy, glucocorticoids carry significant risks. Prolonged use can lead to serious side effects, including increased susceptibility to infection, stunted growth in children, weight gain, diabetes, bone brittleness, and physical changes such as facial swelling. Because of these risks, they are often used as part of a carefully managed therapeutic regimen to balance the necessity of preventing rejection with the potential for injurious health effects.14