Steroid sparing protocols following nonrenal transplants; the evidence is not there. A systematic review and meta-analysis

Knight, Simon R.; Morris, Peter J.

doi:10.1111/j.1432-2277.2011.01335.x

Cited by 30 publications

(12 citation statements)

References 37 publications

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“…Future clinical trials are needed to study the impact of interventions that reduce the risk of CHD, NODAT, and also metabolic syndrome. Such trials could study the impact of steroid avoidance [35], CNI withdrawal [36], switching from CNIs to mTOR inhibitors [37], and higher doses of mycophenolate mofetil along with lower levels of CNIs, on modifying the risks of CHD, NODAT, and metabolic syndrome. Trials studying new agents that increase HDL cholesterol could test whether or not these agents modify the risks of CHD and metabolic syndrome [38].…”

Section: Discussionmentioning

confidence: 99%

Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant

Israni¹,

Snyder²,

Skeans³

et al. 2012

Transplant International

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Summary Metabolic syndrome is associated with coronary heart disease (CHD) and new‐onset diabetes after kidney transplant (NODAT). Using data collected from transplant centers worldwide for the Patient Outcomes in Renal Transplantation study, we examined associations of metabolic syndrome (n = 2253 excluding recipients with diabetes pretransplant), CHD (n = 2253), and NODAT (n = 1840 further excluding recipients with diabetes in the first year post‐transplant), with the primary outcome of allograft failure. We assessed risk factors associated with secondary outcomes of metabolic syndrome, NODAT, and CHD after adjusting for type of baseline immunosuppression and transplant center effects. Metabolic syndrome prevalence was 39.8% at 12–24 months post‐transplant and 35.4% at 36–48 months. Metabolic syndrome was independently associated with NODAT (hazard ratio 3.46, 95% confidence interval 2.40–4.98, P < 0.0001), CHD (2.03, 1.16–3.52, P = 0.013), and allograft failure (1.36, 1.03–1.79, P = 0.028). Allograft failure occurred in 218 patients (14.6%). After adjustment for metabolic syndrome, NODAT (1.63, 1.18–2.24, P = 0.003) and CHD (5.48, 3.27–9.20, P < 0.0001) remained strongly associated with increased risk of allograft failure. Metabolic syndrome, NODAT, and CHD are risk factors for allograft failure. NODAT and CHD are risk factors for allograft failure, independent of metabolic syndrome.

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Section: Discussionmentioning

confidence: 99%

Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant

Israni¹,

Snyder²,

Skeans³

et al. 2012

Transplant International

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“…Three meta-analyses[9-11] were published prior to the date of submission by Lan et al[1]. Two further meta-analyses have been published since this date[12,13].…”

Section: To the Editormentioning

confidence: 99%

Duplicate publication bias weakens the validity of meta-analysis of immunosuppression after transplantation

Fairfield

Wigmore

2017

WJG

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Duplicate publication can introduce significant bias into a meta-analysis if studies are inadvertently included more than once. Many studies are published in more than one journal to maximize readership and impact of the study findings. Inclusion of multiple publications of the same study within a meta-analysis affords inappropriate weight to the duplicated data if reports of the same study are not linked together. As studies which have positive findings are more likely to be published in multiple journals this leads to a potential overestimate of the benefits of an intervention. Recent advances in immunosuppression strategies following liver transplantation have led to many studies investigating immunosuppressive regimes including immunosuppression monotherapy. In this letter we focus on a recently published meta-analysis by Lan et al investigating studies assessing immunosuppression monotherapy for liver transplantation. The authors claim to have identified fourteen separate randomised studies investigating immunosuppression monotherapy. Seven of the references appear to relate to only three studies which have been subject to duplicate publication. Several similarities can be identified in each of the duplicate publications including similar authorship, identical immunosuppression regimes, identical dates of enrolment and citation of the original publication in the subsequent manuscripts. We discuss the evidence of the duplicate publication inclusion in the meta-analysis.

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“…On the other hand, many trials focus on tolerance induction and minimization protocols to reduce the rate of immunosuppression-related complications. Steroid sparing or withdrawal showed no difference in acute rejection rate, graft or patient survival [79]. Markers of operational tolerance are extensively sought, and protocols of weaning therapy in patients with stable long-term function and no signs of rejection have been tested, with 20% successful withdrawal rate [80].…”

Section: Liver Transplantationmentioning

confidence: 99%

Progress in abdominal organ transplantation

et al. 2011

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SummaryThe excellent results of vascularized organ transplantation have resulted in an increasing number of end-stage organ failure patients seeking such treatment. The results of organ transplantation depend on a number of factors – the quality of the donor (and an organ), living vs. deceased donation, magnitude of ischemic injury (and its prevention), and recipient-dependent factors. Ischemia/reperfusion injury in organ transplantation is a multifactorial process, which may lead to delayed graft function. In addition, surgical and preservation techniques, type of immunosuppressive regimens, complications after transplantation and post-transplant management may also have a significant impact on short- and long-term results of transplantation. In this paper we describe advances in transplantation in recent years, with particular emphasis on kidney, liver, intestines, whole pancreas and pancreatic islets.

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Steroid sparing protocols following nonrenal transplants; the evidence is not there. A systematic review and meta-analysis

Cited by 30 publications

References 37 publications

Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant

Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant

Duplicate publication bias weakens the validity of meta-analysis of immunosuppression after transplantation

Progress in abdominal organ transplantation

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