Published in:Journal of the American Society of Nephrology
Language:
English
DOI:
10.1681/asn.v11101910
ISSN:
1046-6673
Origination:
Footnote:
Description:
<jats:sec>
<jats:title>Abstract.</jats:title>
<jats:p>Since the publication of previous meta-analyses of cyclosporine (CsA) and prednisone withdrawal in renal transplant recipients, several additional randomized controlled trials with longer follow-up have been reported. Currently, in nine prednisone withdrawal trials (<jats:italic toggle="yes">n</jats:italic> = 1461), the proportion of patients with acute rejection was increased by 0.14 (95% confidence interval = 0.10 to 0.17, <jats:italic toggle="yes">P</jats:italic> < 0.001). In nine prednisone withdrawal trials (<jats:italic toggle="yes">n</jats:italic> = 1899), the relative risk (RR; RR = 1.0 indicates no risk) of graft failure after withdrawal was also increased (RR = 1.40; range, 1.09 to 1.70, <jats:italic toggle="yes">P</jats:italic> = 0.012). There was no evidence of between-study heterogeneity for either acute rejection or graft failure in the prednisone withdrawal trials by a χ<jats:sup>2</jats:sup> test (<jats:italic toggle="yes">P</jats:italic> > 0.05). In 10 CsA withdrawal trials (<jats:italic toggle="yes">n</jats:italic> = 1049), the proportion of patients with acute rejection was increased by 0.11 (0.07 to 0.15, <jats:italic toggle="yes">P</jats:italic> < 0.001). In 12 trials (<jats:italic toggle="yes">n</jats:italic> = 1151), the RR of graft failure after CsA withdrawal was 1.06 (95% confidence interval, 0.82 to 1.29, <jats:italic toggle="yes">P</jats:italic> = 0.646), but a χ<jats:sup>2</jats:sup> test indicated that there was study heterogeneity. However, there was no evidence of heterogeneity in the six studies (<jats:italic toggle="yes">n</jats:italic> = 632) with at least 4.0 yr (5.8 ± 1.7) of follow-up (RR = 0.92; range, 0.64 to 1.20, <jats:italic toggle="yes">P</jats:italic> = 0.569) or in the seven trials (<jats:italic toggle="yes">n</jats:italic> = 962) published in peer-reviewed journals (RR = 0.95; range, 0.70 to 1.20 <jats:italic toggle="yes">P</jats:italic> = 0.682). Finally, in three trials (<jats:italic toggle="yes">n</jats:italic> = 259) that compared CsA and prednisone withdrawal, there was a nonsignificant trend for less graft failure with CsA withdrawal (RR = 0.63; range, 0.08 to 1.16, <jats:italic toggle="yes">P</jats:italic> = 0.190). Thus, unlike prednisone withdrawal, CsA withdrawal in select patients seems to impart little risk of long-term graft failure.</jats:p>
</jats:sec>