Steroid withdrawal or avoidance is safe in high‐risk kidney transplants: A systematic review and meta‐analysis

Abstract

The present study is aimed to assess the safety and efficacy of steroid withdrawal or avoidance (SWA) in high‐risk kidney transplant (HRKT). We performed a systematic review of the literature and pooled analysis of the available data concerning SWA following HRKT. HRKT is associated with patients undergoing repeat kidney transplantation, in African American recipients, or in patients with panel‐reactive antibody levels >20%. Seven cohort studies and one randomized controlled trial, involving a total of 22 075 patients, were included. Pooled analysis to estimate the risk ratio (RR) and 95% confidence interval (CI) demonstrated comparable graft loss (RR = 0.91, 95% CI 0.76‐1.09) between the SWA and corticosteroid maintenance groups, but with reduced mortality in the SWA group (RR = 0.90, 95% CI 0.84‐0.98). A subanalysis suggested that SWA was not associated with increased graft loss in patients undergoing steroid withdrawal within 1 week of transplantation, in African American recipients, or in patients with follow‐up >5 years. Additionally, SWA was associated with reduced death in those undergoing withdrawal within 1 week (RR = 0.90, 95% CI 0.84‐0.98), in African Americans (RR = 0.90, 95% CI 0.83‐0.98), and in those with follow‐up extended to >5 years (RR = 0.91, 95% CI 0.84‐0.98). SWA was not associated with an increased risk of acute rejection (RR = 0.95, 95% CI 0.75‐1.21) or cytomegalovirus infection (RR = 1.86, 95% CI 1‐3.47); however, it was associated with a reduced risk of posttransplant diabetes mellitus (RR = 0.60, 95% CI 0.37‐0.97). SWA following HRKT is safe in terms of graft survival and rejection, and patients undergoing an SWA regimen had a lower risk of death and posttransplant diabetes mellitus. Future prospective studies are required to confirm these findings.

Isolation and Characterization of Flavonoids from Black Glutinous Rice (Oryza Sativa L. Var Glutinosa)

“…The absorption band is in conjugated diene absorption in the transition π → π * in the area ≥ 270 nm. This shows the double bond in the conjugated flavonoid powder [12]. The addition of NaOH shear reactor causes a shift in wavelength to show the presence of OH on ring B [14] anthocyanin and anthocyanidin compounds will decompose with the addition of NaOH.…”

The Toxicity of Corticosteroids

“…However, a recent meta-analysis reported results in favor of steroid discontinuation even in subjects considered to be at high immunological risk. 26 GN-IgA is also considered as a contraindication to the steroid discontinuation. An association was reported between steroid discontinuation and an increased risk of GN-IgA recurrence.…”

Current status of glucocorticoid usage in solid organ transplantation

“…Steroid withdrawal was initiated within 1 wk after transplantation in many of these patients. Based on this meta-analysis, steroid withdrawal within 1 wk after transplantation was associated with significant reduced risk of patient death[ 10 ].…”

“…Although other components of the immunosuppressive regimen, such as the type of CNI (tacrolimus vs cyclosporine A), can affect PTDM risk, as in the multivariate analysis of Tillmann et al ’s[ 108 ] study showed higher risk of prediabetes with long-term low-dose steroid, independent of the higher risk of tacrolimus inducing PTDM compared with cyclosporine. On the other hand, a meta-analysis on more than 22000 kidney transplant patients found that early steroid withdrawal during 1 wk after transplantation is associated with less PTDM risk (RR: 0.91; 95%CI: 0.37-0.97; P = 0.04)[ 10 ]. Association between new-onset hyperglycemia and GC-containing maintenance immunosuppression among liver transplant recipients is controversial[ 109 , 110 ].…”