Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding of outcome assessment) and by imprecise results (small trials with few patients and outcome events).
A Cochrane review included 16 studies with a total of 1347 subjects. 10 trials that assessed complete postoperative glucocorticosteroid avoidance (excluding intra-operative use and treatment of rejection) vs short-term glucocorticosteroids (n=782) and 6 trials that assessed short-term glucocorticosteroids vs long-term glucocorticosteroids (n=565). Overall, we found no statistically significant difference for mortality, graft loss including death, or infection when glucocorticosteroid avoidance or withdrawal was compared with glucocorticosteroid-containing immunosuppression . Acute rejection and glucocorticosteroid-resistant rejection were more frequent when glucocorticosteroid avoidance or withdrawal was compared with glucocorticosteroid-containing immunosuppression (RR 1.33, 95% CI 1.08 to 1.64; moderate-quality evidence; and RR 2.14, 95% CI 1.13 to 4.02; very low-quality evidence). Diabetes mellitus and hypertension were less frequent when glucocorticosteroid avoidance or withdrawal was compared with glucocorticosteroid-containing immunosuppression (RR 0.81, 95% CI 0.66 to 0.99; low-quality evidence; and RR 0.76, 95% CI 0.65 to 0.90; low-quality evidence).
| Outcome | Relative effect (95% CI) | Assumed risk = glucocorticosteroid-based immunosuppression | Corresponding risk - intervention = No glucocorticosteroid | Number of participants (studies) |
|---|---|---|---|---|
| Mortality | 1.15 (0.93 to 1.44) | 204/1000 | 234/1000 (189 to 293) | 1323 (15) |
| Graft loss incl. death | 1.16 (0.91 to 1.48) | 218/1000 | 253/1000 (198 to 322) | 1002 (11) |
| Acute rejection | 1.33 (1.08 to 1.64) | 194/1000 | 257/1000 (209 to 317) | 1347 (16) |
| Infection | 0.88 (0.73 to 1.05) | 402/1000 | 354/1000 (293 to 422) | 778 (8) |
Date of latest search: 11 December 2015