Servicio de Nefrología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Nephrol Dial Transplant. 2012 Feb;27(2):825-32. doi: 10.1093/ndt/gfr374. Epub 2011 Jul 22.
The safety and efficacy of early steroid withdrawal or avoidance in patients receiving a kidney transplant (KT) are controversial.
We performed a systematic review and a meta-analysis of the randomized controlled studies about steroid avoidance or withdrawal after a few days in patients receiving a KT and treated with antibody induction and cyclosporine (CsA) or tacrolimus (Tac) plus mycophenolate mofetil (MMF) (nine available studies and 1934 participants).
Death and graft loss (including or excluding death with function) were similar in steroid avoidance and control patients, with no differences between CsA and Tac studies. After steroid avoidance, acute rejection was more frequent than conventional steroid use in CsA trials [risk ratios (RR) 1.59, 95% confidence intervals (95% CI) 1.01-2.49] but not when Tac was used (RR 1.06, 95% CI 0.79-1.42). Steroid avoidance was associated with less frequent new-onset diabetes mellitus, but this decrease was only evident with CsA (RR 0.54, 95% CI 0.30-0.98), whereas this difference was not significant analysing Tac studies (RR 0.75, 95% CI 0.32-1.77). Despite this trend, the corresponding interaction tests were not statistically significant (P = 0.140 and P = 0.535, for acute rejection and new-onset diabetes mellitus, respectively). Serum creatinine, creatinine clearance, mean blood pressure, serum cholesterol and serum triglycerides were similar in both groups.
Steroid avoidance or early withdrawal within the first 2 weeks is safe in KT recipients receiving induction with anti-interleukin-2 receptor antibodies or thymoglobulin and a drug regimen based on calcineurin inhibitor and MMF. However, the real benefits remain unclear.
在接受肾移植（KT）的患者中，早期停用或避免使用类固醇的安全性和疗效存在争议。
我们对接受抗体诱导和环孢素（CsA）或他克莫司（Tac）加霉酚酸酯（MMF）治疗的 KT 患者在数天后避免或停用类固醇的随机对照研究进行了系统评价和荟萃分析（九项研究，1934 名参与者）。
在避免类固醇和对照组患者中，死亡和移植物丢失（包括或不包括带功能的死亡）相似，CsA 和 Tac 研究之间无差异。在避免类固醇后，CsA 试验中急性排斥反应的频率高于常规使用类固醇[风险比（RR）1.59，95%置信区间（95%CI）1.01-2.49]，但 Tac 试验中并非如此（RR 1.06，95%CI 0.79-1.42）。避免使用类固醇与新发糖尿病的频率较低相关，但这种减少仅在使用 CsA 时明显（RR 0.54，95%CI 0.30-0.98），而在分析 Tac 研究时则不显著（RR 0.75，95%CI 0.32-1.77）。尽管存在这种趋势，但相应的交互检验并无统计学意义（P = 0.140 和 P = 0.535，分别用于急性排斥反应和新发糖尿病）。两组间血肌酐、肌酐清除率、平均血压、血清胆固醇和血清甘油三酯相似。
在接受白细胞介素-2 受体抗体或胸腺球蛋白诱导及基于钙调磷酸酶抑制剂和霉酚酸酯的药物方案治疗的 KT 受者中，在前 2 周内避免或早期停用类固醇是安全的。然而，实际获益仍不明确。
