Steroid avoidance or withdrawal for kidney transplant recipients

Haller, Maria; Royuela, Ana; Nagler, Evi; Pascual, Julio; Webster, Angela C

doi:10.1002/14651858.cd005632.pub3

Cited by 141 publications

(137 citation statements)

References 191 publications

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“…Steroid withdrawal at 3-6 months after transplantation is categorized as early withdrawal while withdrawal after 6 months and above after transplantation is considered as late withdrawal [1,7].…”

Section: Defi Nitionsmentioning

confidence: 99%

“…Irrespective of their capability in preventing acute rejection, steroids are known to be associated with adverse effects including weight gain, osteoporosis, cataracts, glaucoma, skin atrophy, diabetes mellitus, hyperlipidaemia, avascular necrosis, myopathy and increased infection risk [1,2,3]. In order to reduce the adverse effects, clinicians tended to reduce the dosages of steroids in immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

“…Induction has been shown to reduce AR. The maintenance immunosuppression includes a calcineurin inhibitor such as CsA or TAC, antiproliferative agent such as MMF or azathioprine (AZA) and a corticosteroid [1]. Steroids promote the activity of uridine diphosphate in mycophenolic acid metabolism.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Halawa¹

2017

Arch Organ Transplant

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Section: Defi Nitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Halawa¹

2017

Arch Organ Transplant

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“…25 Some transplant units withdraw steroids in the first few weeks after transplantation. 26 Ciclosporin and azathioprine are still used in selected recent transplant recipients and in many who were transplanted more than 10 years ago.…”

Section: Immunosuppressionmentioning

confidence: 99%

Renal transplantation in adults

Nieto

Inston

Cockwell

2016

BMJ

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“…Despite the development of novel immunosuppressants in recent years, serious side effects, such as increased cardiovascular risk, impaired immune system detection of cancer cells and antiviral defense, still result from long-term intake of immunosuppressive drugs. Therefore, various strategies to reduce immunosuppression are being investigated with the aim to alleviate toxicity associated with this treatment [7–11]. …”

Section: Introductionmentioning

confidence: 99%

Steroid withdrawal after renal transplantation: a retrospective cohort study

Haller

Kammer

Kainz

et al. 2017

BMC Med

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BackgroundImmunosuppressive regimens in renal transplantation frequently contain corticosteroids, but many centers withdraw steroids as a consequence of unwanted side effects of steroids. The optimal timing to withdraw steroids after transplantation, however, remains unclear. The aim of this study was to determine an optimal time point following kidney transplantation that is associated with reduced mortality without jeopardizing the allograft to allow safe discontinuation of steroids.MethodsWe conducted a retrospective cohort study and computed a concatenated landmark-stratified Cox supermodel to estimate hazard ratios and 95% confidence intervals for mortality and graft loss using dynamic propensity score matching to adjust for confounding by indication.ResultsA total of 6070 first kidney transplant recipients in the Austrian Dialysis and Transplant Registry who were transplanted between 1990 and 2012 were evaluated and classified according to steroid treatment status throughout follow-up after kidney transplantation; 2142 patients were withdrawn from steroids during the study period. Overall, 1131 patients lost their graft and 821 patients in the study cohort died. Steroid withdrawal within 18 months after transplantation was associated with an increased rate of graft loss compared to steroid maintenance during that time (6 months after transplantation: HR = 1.8; 95% CI, 1.3 to 2.6; 18 months after transplantation: HR = 1.3; 95% CI, 1.1 to 1.6; 24 months after transplantation: HR = 1.2; 95% CI, 0.9 to 1.5), while mortality was not different between groups.ConclusionsOur findings suggest that steroid withdrawal after anti-IL-2 induction in the first 18 months after transplantation is associated with an increased risk of allograft loss.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0772-6) contains supplementary material, which is available to authorized users.

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Steroid avoidance or withdrawal for kidney transplant recipients

Cited by 141 publications

References 191 publications

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Defining a Steroid Withdrawal Protocol in a newly established Kidney Transplantation Unit

Renal transplantation in adults

Steroid withdrawal after renal transplantation: a retrospective cohort study

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