Successful withdrawal of steroid after renal transplantation

Steroid Withdrawal in Renal Transplant Patients on Triple Therapy with a Calcineurin Inhibitor and Mycophenolate Mofetil: A Meta-analysis of Randomized, Controlled Trials

“…At last follow-up, total cholesterol was significantly lower in steroid withdrawal groups in four trials (15)(16)(17)19) and similar in the other two trials (18,20) (Table 3). In fact, it was lower in all trials well powered to detect such differences in terms of adequate number of patients.…”

“…A second review allowed exclusion of 83 articles because they were not randomized trials or they were actually steroid-avoidance or steroid-free trials. As a result, 34 articles were selected for more detailed evaluation , and 6 of them were considered appropriate to be included in meta-analysis (Table 1) (15)(16)(17)(18)(19)(20). The principal reasons for exclusion were repeated reports, subgroup analysis of unique trials, and insufficient outcome data reported.…”

“…Four of the six trials examined prednisone withdrawal in renal allograft recipients treated with triple-therapy cyclosporine, MMF, and steroids (15)(16)(17)(18). The other two trials examined prednisone withdrawal in patients receiving tacrolimus, MMF, and steroids (19,20).…”

“…The six trials included 1,519 patients, 763 in withdrawal arms and 756 in maintenance arms. In three trials, patients were randomized only if they did not have developed acute rejection (15,18,20), and in another two trials only if they did not have repeated, severe, or vascular acute rejection (17,19). In the other trial, randomization was performed on the day of transplantation, so that acute rejection was not a criterion for withdrawing steroids or not (16).…”

Immunosuppressive agents in solid organ transplantation: Mechanisms of action and therapeutic efficacy

“…Serum creatinine levels tended to be higher after steroid withdrawal. Further randomised controlled studies have confirmed that the incidence of acute rejection is similar or higher in patients undergoing steroid withdrawal at 3 months post-transplantation, though benefits include improvement in hypertension, hypercholesterolaemia and bone density [47][48][49][50].…”