Document Detail


Steroid avoidance or withdrawal after renal transplantation increases the risk of acute rejection but decreases cardiovascular risk. A meta-analysis.
MedLine Citation:
PMID:  20061913     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The morbidity related to long-term steroid therapy has led to continued interest in withdrawal of steroids from immunosuppressant regimens after renal transplantation. A number of recent trials have provided long-term information regarding the risks and benefits of steroid avoidance or withdrawal (SAW).
METHODS: A literature search was performed using Ovid Medline, Embase, the Cochrane Library, and the Transplant Library. Randomized controlled trials comparing a maintenance steroid group with complete avoidance or withdrawal of steroids were selected. All studies were assessed for methodological quality. Trials were pooled by meta-analysis to provide summary effects (relative risk [RR] or weighted mean difference) with 95% confidence intervals (CI).
RESULTS: Thirty-four studies including 5,637 patients met the inclusion criteria. SAW regimens significantly increased the risk of acute rejection (AR) over maintenance steroids (RR 1.56, CI 1.31-1.87, P<0.0001). No significant differences in corticosteroid resistant AR, patient survival, or graft survival were observed. Serum creatinine was increased and creatinine clearance was reduced with SAW. Cardiovascular risk factors including incidence of hypertension (RR 0.90, CI 0.85-0.94, P<0.0001), new onset diabetes (RR 0.64, CI 0.50-0.83, P=0.0006), and hypercholesterolemia (RR 0.76, CI 0.67-0.87, P<0.0001) were reduced significantly by SAW.
CONCLUSION: Despite an increase in the risk of AR with SAW protocols, there is only a small effect on graft function with no measurable effect on graft or patient survival. There are significant benefits in cardiovascular risk profiles after SAW. SAW protocols would seem justified with current immunosuppressive protocols in low-risk recipients.
Authors:
Simon R Knight; Peter J Morris
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Transplantation     Volume:  89     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-11     Completed Date:  2010-02-01     Revised Date:  2011-12-30    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-14     Citation Subset:  IM    
Affiliation:
Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / adverse effects*,  therapeutic use
Cardiovascular Diseases / chemically induced*,  epidemiology,  prevention & control
Graft Rejection / prevention & control*
Humans
Immunosuppressive Agents / therapeutic use
Kidney Transplantation / immunology*
Meta-Analysis as Topic
Patient Selection
Survivors
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Immunosuppressive Agents
Comments/Corrections
Comment In:
Transplantation. 2011 Dec 15;92(11):e63-4   [PMID:  22108427 ]
Transplantation. 2011 Mar 15;91(5):e26   [PMID:  21336083 ]

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