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Deprecated: Implicit conversion from float 253.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 PLoS+One 2016 ; 11 (3): ä Nephropedia Template TP
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Steroid Avoidance or Withdrawal Regimens in Paediatric Kidney Transplantation: A Meta-Analysis of Randomised Controlled Trials #MMPMID26991793
Zhang H; Zheng Y; Liu L; Fu Q; Li J; Huang Q; Liu H; Deng R; Wang C
PLoS One 2016[]; 11 (3): ä PMID26991793show ga
Background: We combined the outcomes of all randomised controlled trials to investigate the safety and efficacy of steroid avoidance or withdrawal (SAW) regimens in paediatric kidney transplantation compared with steroid-based (SB) regimens. Methods: A systematic literature search of PubMed, Embase, Cochrane Library, the trials registry and BIOSIS previews was performed. A change in the height standardised Z-score from baseline (?HSDS) and acute rejection were the primary endpoints. Results: Eight reports from 5 randomised controlled trials were included, with a total of 528 patients. Sufficient evidence of a significant increase in the ?HSDS was observed in the SAW group (mean difference (MD) = 0.38, 95% confidence interval (CI) 0.07?0.68, P = 0.01), particularly within the first year post-withdrawal (MD = 0.22, 95% CI 0.10?0.35, P = 0.0003) and in the prepubertal recipients (MD = 0.60, 95% CI 0.21?0.98, P = 0.002). There was no significant difference in the risk of acute rejection between the groups (relative risk = 1.04, 95% CI 0.80?1.36, P = 0.77). Conclusions: The SAW regimen is justified in select paediatric renal allograft recipients because it provides significant benefits in post-transplant growth within the first year post-withdrawal with minimal effects on the risk of acute rejection, graft function, and graft and patient survival within 3 years post-withdrawal. These select paediatric recipients should have the following characteristics: prepubertal; Caucasian; with primary disease not related to immunological factors; de novo kidney transplant recipient; with low panel reactive antibody.