Tan J Y, Zhao N, Wu T X, Yang K H, Zhang J D, Tian J H, Liu Y L, Wang K J, Chen F, Li S F, Li Y P
Key Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu 610041, P.R. China.
Transplant Proc. 2006 Sep;38(7):2054-6. doi: 10.1016/j.transproceed.2006.06.039.
To evaluate the safety of steroid withdrawal in renal transplantation recipients.
These following databases were searched: Medline (1966 to September 2005), OVID (1966 to 2004), Embase (1984 to 2004), Cochrane library (issue 4, 2005), Highwire (1849 to September 2005), American Transplant Congress (2005), Chinese Biomedicine database (CBM 1994 to 2005). The safety was measured by the following factors: patient and graft survival, acute rejection, chronic rejection, infection, serum creatinine. We performed meta-analysis by using Revman 4.2.7.
Nine randomized clinical trials were identified to have a steroid withdrawal and a steroid continuing group. They included 1681 patients: 845 with steroid withdrawal and 836 with continuing steroid. The risk of acute rejection after steroid withdrawal was two times higher than steroid-continuing group (RR 2.05; 95% confidence interval [CI]: 1.54, 2.72; P < .00001), while the incidence of opportunistic infection and urinary tract infection of steroid withdrawal group were lower than the control group (RR 0.80; 95%CI 0.64, 1.00; P = .05 vs RR 0.74; 95%CI, 0.60, 0.92; P = .004, respectively). The graft and patient survivals, chronic rejection, and serum creatinine were similar to the steroid continuing group.
Steroid withdrawal can significantly increase the risk of acute rejection episodes, but reduces the incidence of infection to a certain extent. To prophylaxis against serious infection, steroid withdrawal is worth considering using a sufficient immunosuppressive regimen. The key point is to balance the benefit and harm for the individual recipient.
评估肾移植受者停用类固醇药物的安全性。
检索了以下数据库：医学期刊数据库（1966年至2005年9月）、OVID数据库（1966年至2004年）、荷兰医学文摘数据库（1984年至2004年）、考科蓝图书馆（2005年第4期）、Highwire数据库（1849年至2005年9月）、美国移植大会（2005年）、中国生物医学数据库（中国生物医学文献数据库1994年至2005年）。通过以下因素衡量安全性：患者和移植物存活率、急性排斥反应、慢性排斥反应、感染、血清肌酐。使用Revman 4.2.7进行荟萃分析。
确定有9项随机临床试验，分为停用类固醇药物组和继续使用类固醇药物组。共纳入1681例患者：845例停用类固醇药物，836例继续使用类固醇药物。停用类固醇药物后急性排斥反应的风险比继续使用类固醇药物组高两倍（相对危险度2.05；95%置信区间[CI]：1.54，2.72；P <.00001），而停用类固醇药物组的机会性感染和尿路感染发生率低于对照组（相对危险度分别为0.80；95%CI 0.64，1.00；P = 0.05和相对危险度0.74；95%CI，0.60，0.92；P = 0.004）。移植物和患者存活率、慢性排斥反应以及血清肌酐与继续使用类固醇药物组相似。
停用类固醇药物可显著增加急性排斥反应发作的风险，但在一定程度上降低感染发生率。为预防严重感染，在采用充分的免疫抑制方案的情况下，停用类固醇药物值得考虑。关键是要平衡个体受者的利弊。
