The 2009 Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines suggest that high-dose steroids are the primary treatment for acute T-cell mediated rejection. However, they acknowledge that the exact dosage and duration of treatment has not yet been clearly defined by randomised controlled trials.

Using a standard high-dose steroid regimen for everyone may cause serious side effects, including infections, mental health issues, high blood pressure, diabetes, and bone problems like osteoporosis and fractures. These complications become more severe with higher steroid doses.

In the first six months after a kidney transplant, high-dose steroids can increase the risk of deadly opportunistic infections like Pneumocystis, Cryptococcal, and Aspergillus pneumonia, which have a high mortality rate within a year.

Additionally, as the kidney transplant population ages, older recipients may be more vulnerable to the negative effects of immunosuppressive therapy, increasing their risk of death even though their transplanted kidneys are functioning properly.