Objective: To evaluate the effect of steroids avoidance or withdrawal (SAW) protocol on pediatric recipients by performing a meta-analysis of randomized controlled trials (RCTs).

Method: A systematic literature search was performed using Pubmed, OVID EMBASE and Evidence-based Reviews which include Cochrane Database of Systematic Reviews (CDSR). All prospective RCTs comparing steroids-free (SB) regimen with SAW regimen in pediatric renal transplantation were selected. All studies were evaluated for clinical heterogeneity and methodological quality. The extracted data were pooled by meta-analysis to provide summary effects (relative risk [RR] or weighted mean difference [WMD]) with 95% confidence intervals (CI). The primary endpoint was height Standardized Z-scores (SDS) change, and acute rejection (AR) rate, graft function and incidence of complications were the second endpoints. Subgroup analyses and sensitivity analyses were performed.

Results: Ten publications from 5 eligible RCTs were selected, with 530 patients involved. For height SDS change, no significant difference was found between SAW and SB groups when all age grouped together (WMD 0.35, CI -0.01–0.71, P=0.06). However, the prepubertal patients did have a higher height SDS increment in the SAW group compared with the SB group (WMD 0.60, CI 0.22–0.97, P=0.002). For secondary endpoints, no significant difference was observed either in the risk of AR (RR 0.82, CI 0.52–1.29, P=0.40) or graft function reported as creatinine clearance or estimated glomerular filtration rate (WMD -0.12, CI -3.24– -3.00, P=0.94). There was also no significant difference in either the risk of cytomegalovirus infection (RR 1.03, CI 0.61–1.75, P=0.90) or urinary tract infection (RR 1.05, CI 0.77–1.43, P=0.77). The risk of hyperglycemia was significantly reduced in SAW group (RR 0.25, CI 0.10–0.66, P=0.005) and no significant difference was identified in the risk of hypertension (RR 0.82, CI 0.56–1.19, P=0.30). Anemia was of greater risk in SAW group (RR 1.73, CI 1.16–2.57, P=0.007) compared with SB group.

Conclusion: SAW regimen is beneficial to the catch-up growth in prepubertal recipients after kidney transplantation, and does not increase the risk of AR or decrease the eGFR. It is also protective from hyperglycemia. However, more high-quality clinical trials are required for the validation of SAW regimen since the size of participants is limited in the present study.

CITATION INFORMATION: Deng R, Zhang H, Zheng Y, Liu L, Wang C. Pediatric Patients Benifit from Steroids Free Regimen After Kidney Transplantation: A Meta-Analysis. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress