Steroid Avoidance or Withdrawal After Renal Transplantation Increases the Risk of Acute Rejection but Decreases Cardiovascular Risk. A Meta-Analysis

Knight, Simon R.; Morris, Peter J.

doi:10.1097/tp.0b013e3181c518cc

Cited by 230 publications

(186 citation statements)

References 85 publications

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“…Older randomized trials demonstrated improvement in all of these parameters with implementation of steroid withdrawal or steroid-free immunosuppression (28). A recent meta-analyses of 34 randomized trials of steroid-free immunosuppression concluded that elimination of steroids was associated with improvements in hypertension, hyperlipidemia, and the incidence of new-onset diabetes after transplantation (29). The last two reports are flawed by their inclusion of older trials in which immunosuppression was dominated by the use of cyclosporine and relatively high dosages of maintenance corticosteroids.…”

Section: Role Of Immunosuppressionmentioning

confidence: 99%

Metabolic Syndrome in Kidney Transplantation

Hricik¹

2011

Clinical Journal of the American Society of Nephrology

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The metabolic syndrome is a constellation of clinical abnormalities related to insulin resistance and inflammation. The syndrome is now recognized as a risk factor for diabetes and cardiovascular disease in the general population. Recent studies suggest that the metabolic syndrome is common after kidney transplantation, also possibly being predictive of allograft loss and poor allograft function. The development or worsening of obesity plays a central role in the development of metabolic syndrome after kidney transplantation. Immunosuppression also plays an important role in the pathogenesis of the individual components of the metabolic syndrome. In fact, the overriding influence of immunosuppressive medications makes it unclear whether the metabolic syndrome has the same value in predicting outcomes as is true in the general population. However, recent studies suggest that the presence of metabolic syndrome before transplantation predicts the subsequent development of new-onset diabetes after transplantation, independent of other widely known risk factors. Aggressive management of the metabolic syndrome is warranted both before and after transplantation.

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Section: Role Of Immunosuppressionmentioning

confidence: 99%

Metabolic Syndrome in Kidney Transplantation

Hricik¹

2011

Clinical Journal of the American Society of Nephrology

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“…Meta-analyses of randomized controlled trials of steroid withdrawal have demonstrated similar transplant outcomes despite an increased risk for acute rejection with early steroid withdrawal when compared to steroid maintenance. [8][9][10] A registry analysis by Luan and associates showed a reduced risk for graft failure and patient death at 1 and at 4 years in kidney transplant recipients continued on a steroid-free regimen. 11 The 5-year prospective randomized trial by Woodle and associates demonstrated reductions in weight gain, new onset of type 2 diabetes mellitus after transplant, and hypertriglyceridemia in kidney transplant recipients randomized to early steroid withdrawal following antibody induction and calcineurin inhibitor and mycophenolate mofetil maintenance.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: This study explored the safety of early steroid withdrawal in recipients of expanded criteria deceased-donor kidney transplants. Materials and Methods: Using the Organ Procurement and Transplant Network-United Network of Organ Sharing database, we identified patients who underwent expanded criteria deceased-donor kidney transplant between January 2000 and December 2008 after receiving induction with rabbit-antithymocyte globulin (n = 3717), alemtuzumab (n = 763), or interleukin 2 blocking agent (n = 2600) followed by calcineurin inhibitor and mycophenolate mofetilbased maintenance with and without steroid therapy. Results: Adjusted overall graft survival (hazard ratio 1.32; 95% confidence interval, 1.1-1.56; P = .002) and patient survival (hazard ratio 1.46, 95% confidence interval, 1.16-1.83, P = .001) were inferior, whereas death-censored graft survival (hazard ratio 1.13; 95% confidence interval, 0.87-1.47; P = .35) was similar for chronic steroid maintenance versus early steroid withdrawal groups in rabbit-antithymocyte globulininduced patients. Graft and patient outcomes were similar for chronic steroid maintenance versus early steroid withdrawal groups among alemtuzumab and interleukin 2 blocking agent-induced patients. Among rabbit-antithymocyte globulin-induced patients, adjusted overall graft survival (hazard ratio 1.57; 95% confidence interval, 1.2-2.0; P < .001) and patient survival (hazard ratio 1.5; 95% CI, 1.15-2.1; P = .004) were inferior, whereas death-censored graft survival (hazard ratio 1.5; 95% confidence interval, 0.97-2.43; P = .07) trended inferior for chronic steroid maintenance versus early steroid withdrawal groups in recipients > 60 years old (n = 1729). Conclusions: Our study showed safety of early steroid withdrawal in recipients of expanded criteria deceaseddonor kidney transplants who underwent perioperative induction followed by calcineurin inhibitor and mycophenolate mofetil maintenance. Among rabbitantithymocyte globulin-induced patients, chronic steroid maintenance was associated with inferior graft and patient outcomes, an effect limited to older recipients.

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“…29 ). Also single-center studies have demonstrated that oral prednisolone dose reduction to 5 mg daily significantly improves glucose tolerance during the first year after transplantation 30 while a 0.01 mg/kg/day increase in prednisolone dose is associated with a 5% (ref.…”

Section: Glucocorticoidsmentioning

confidence: 99%

New-onset diabetes mellitus after renal transplantation

Goldmannová¹,

Karásek²,

Krystynik³

et al. 2016

BIOMED PAP

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Background and Aim. Diabetes mellitus is a very common metabolic disease with a rising incidence. It is both a leading cause of chronic renal disease and one of the most serious comorbidities in renal transplant recipients. New-onset diabetes after renal transplantation (NODAT) is associated with poor graft function, higher rates of cardiovascular complications and a poor prognosis. The aim of this paper is to review current knowledge of NODAT including risk factors, diagnosis and management. Methods. A MEDLINE search was performed to retrieve both original and review articles addressing the epidemiology, risk factors, screening and management of NODAT. We also focused on microRNAs as potential biomarkers of NODAT. Results and Conclusion. Understanding the risk factors (both modifiable-e.g. obesity, viruses, and unmodifiable-e.g. age, genetics) may help reduce the incidence and impact of NODAT using pre-and post-transplant management. This can lead to better long-term graft function and general transplant success.

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Steroid Avoidance or Withdrawal After Renal Transplantation Increases the Risk of Acute Rejection but Decreases Cardiovascular Risk. A Meta-Analysis

Cited by 230 publications

References 85 publications

Metabolic Syndrome in Kidney Transplantation

Metabolic Syndrome in Kidney Transplantation

Untitled

New-onset diabetes mellitus after renal transplantation

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