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Is it safe to withdraw steroids within seven days of renal transplantation?
Author(s) -
Zhang Xin,
Huang Hejing,
Han Shu,
Fu Shangxi,
Wang Liming
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12015
Subject(s) - medicine , relative risk , regimen , incidence (geometry) , transplantation , randomized controlled trial , tacrolimus , kidney transplantation , diabetes mellitus , renal function , confidence interval , meta analysis , surgery , urology , gastroenterology , endocrinology , physics , optics
Background The safety of very early steroid withdrawal ( VESW ) in renal transplant recipients remains unclear. Methods Literature searches for all randomized controlled trials comparing VESW with steroid maintenance regimens were performed using MEDLINE , EMBASE , and the C ochrane L ibrary. Quality assessment was performed in each trial. Meta‐analyses were performed to demonstrate the pooled effects of relative risk ( RR ) and weighted mean difference with 95% confidence intervals ( CI ). Results A total of 3520 participants from 15 RCT s were included. VESW regimen increased the incidence of acute rejection ( AR ) over controls ( RR = 1.46, CI = 1.20–1.79, p = 0.04). Subsequent analysis demonstrated that such difference lost significance in patients receiving tacrolimus (p = 0.16), but remained significant in patients with cyclosporin (p < 0.00001). The increased AR episodes were predominantly mild. VESW was associated with an increased incidence of delayed graft function ( DGF ) when steroids were withdrawn within three d post‐transplantation. Cardiovascular risk factors, including incidence of new onset diabetes and total cholesterol, were significantly reduced under VESW regimen. Conclusions It is safe and practical to withdraw steroids very early after renal transplantation. However, a three‐ to seven‐d course of steroids may decrease the risk for DGF relative to steroid withdrawal in <3 d. Antibody induction is effective in preventing early AR .