Mordechai Saeid Nosrati, MD
What is the efficacy and safety of steroid avoidance or withdrawal in kidney transplant recipients?
Included studies evaluated steroid avoidance or withdrawal, with 1 group randomized to steroid avoidance or withdrawal after > 2 weeks of treatment in patients receiving a kidney transplant. Studies of patients receiving multiorgan transplants were excluded. Outcomes included mortality, graft loss (including or excluding mortality), acute rejection, and new-onset diabetes after transplantation.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Renal Group Specialized Register, Cochrane Central Register of Controlled Trials, reference lists, and abstracts from transplantation society meetings were searched for randomized controlled trials (RCTs), quasi-RCTs, and cohort studies. 30 RCTs (n = 5949) met the selection criteria; 16 RCTs had adequate allocation concealment, 5 were double-blind, 24 used intention-to-treat analysis, and 22 had > 80% follow-up.
Steroid sparing and steroid avoidance increased risk for acute rejection but reduced new-onset diabetes compared with steroid maintenance (Table). Steroid sparing or avoidance did not differ from steroid maintenance for mortality or graft loss (Table). Steroid withdrawal did not differ from steroid maintenance for mortality, graft loss, acute rejection, or new-onset diabetes.
Steroid avoidance or withdrawal increases risk for acute graft rejection but does not increase mortality or graft loss in patients receiving a kidney transplant.
Steroid sparing (SS) or steroid avoidance (SA) vs steroid maintenance (SM) in kidney transplant recipients*
*GL = graft loss; NODAT = new-onset diabetes after transplantation; other abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from data in article using a random-effects model.
Nosrati MS. Review: Steroid avoidance or withdrawal does not increase mortality or graft loss in kidney transplant patients. Ann Intern Med. ;151:JC3–11. doi: 10.7326/0003-4819-151-6-200909150-02011
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Published: Ann Intern Med. 2009;151(6):JC3-11.
Nephrology, Renal Replacement Therapy.
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