Steroid avoidance or withdrawal for kidney transplant recipients

Steroid avoidance and steroid withdrawal strategies in kidney transplantation appear not to increased mortality or graft loss despite an increase in acute rejection.

A Cochrane review included 48 studies with a total of 7 803 subjects. Steroid withdrawal or avoidance showed no effect on mortality or graft loss including death (table , ). Steroid avoidance or withdrawal showed a higher risk of graft loss excluding death than conventional steroid use (table , ).

Steroid avoidance and withdrawal strategies showed benefits in reducing antihypertensive drug need, serum cholesterol, antihyperlipidaemic drug need, new-onset diabetes after transplantation (DM) requiring any treatment and cataracts. Steroid avoidance did not alter serum cholesterol, but was associated with less frequent DM requiring any treatment. Cardiovascular events were reduced with steroid avoidance. Reduced antihypertensive drug need and serum cholesterol were similar with CsA or TAC. Reduced antihyperlipidaemic drug need was only evident with TAC, whereas the reduction in DM requiring any treatment was only evident with CsA. Infection was lower in steroid-sparing patients using CsA (RR 0.88, 95% CI 0.78 to 1.00). DM was less frequent with steroid avoidance than with steroid withdrawal.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment in half of the studies).

Ədəbiyyat

1. Pascual J, Zamora J, Galeano C, Royuela A, Quereda C. Steroid avoidance or withdrawal for kidney transplant recipients. Cochrane Database Syst Rev 2009 Jan 21;(1):CD005632 [Assessed as up-to-date: 15 February 2016].