A systematic review including 6 studies with a total of 1519 subjects was abstracted in DARE. Steroid withdrawal in patients on triple therapy including a calcineurin inhibitor (cyclosporine in 4 studies or tacrolimus in 2 studies) and mycophenolate mofetil (MMF) was assessed. The risk ratio (RR) for acute rejection was 2.28 (95% CI 1.65 to 3.16; P < 0.00001) and the pooled risk difference (RD) was 0.08 (95% CI 0.05 to 0.11; P < 0.001), indicating that the proportion of patients with acute rejection after prednisone withdrawal was significantly higher compared with controls. The RR for graft failure was 0.73 (95% CI 0.42 to1.28; P = 0.27) and the RD was -0.01 (95% CI -0.03 to 0.01; P = 0.28), indicating that the proportion of patients with graft failure after withdrawal was not significantly different from that observed in controls. Total cholesterol was significantly lower after steroid withdrawal (WMD -0.53 microM, 95% CI -0.70 to -0.36; P < 0.0001).