April 5, 2012

Very early steroid withdrawal or complete avoidance for kidney transplant recipients: a systematic review

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There have been a number of randomized controlled trials over the last few years comparing early corticosteroid withdrawal post-renal transplant to long-term low-dose steroids. This meta-analysis found nine randomized controlled trials using modern immunosuppression protocols to assess the impact of early steroid withdrawal. Patients received tacrolimus or cyclosporine; mycophenolic acid or an mTOR inhibitor; and almost all patients received some type of antibody induction at time of transplant. Steroid withdrawal was associated with an increased risk of acute rejection, particularly when cyclosporine was used. There was no difference in graft loss or death, but there were also no significant improvements in cardiovascular risk factors with steroid withdrawal. Of note, most of these trials lasted less two years or less.

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