 The adult Kidney Transplant Program has been able to reproduce the pediatric experience with a similarly designed steroid avoidance protocol. A slightly different approach has also been successfully used. Kidney transplant recipients received Thymoglobulin induction in lieu of Zenapax and received 4 small doses of steroids peri-operatively. So far 25 patients were treated with this minimal exposure to steroids. The graft and patient survival is 100 and only one episode of rejection was seen. This approach is preferred to the total avoidance of steroids since it is associated with a better initial kidney function.13 This later approach is currently used by Stanfords Adult Kidney Transplant Program for un-sensitized adult patients receiving a kidney transplant if they have a medical condition that could be exacerbated by the use of steroids; diabetes, obesity, osteopenia, and coronary artery disease. 