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제목	Cardiovascular benefits of steroid avoidance and early steroid withdrawal in renal transplantation: an updated meta-analysis
저자	Pratik Lamichhane
출판정보	2023; 2023(1):
키워드
초록	Objectives: Complete steroid avoidance (SA) or early steroid withdrawal (ESW)(≤7 post-operative days) has been utilized in the maintenance of immunosuppression in renal transplantation since the advent of better immunosuppressants. The cardiovascular benefits of SA/ESW protocol have not been summarized since 2012, despite the publication of new studies. Thus, we conducted an updated meta-analysis to quantify the pooled SA/ESW's beneficial effects on various cardiovascular risk factors. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched from 2000 to 2023. Randomized trials and observational cohort studies exploring the effect of SA/ESW on at least one cardiovascular parameter were included in the analysis. Studies reporting late steroid withdrawal (>8 days), case reports and series, reviews, meta-analyses, letters, and editorials were excluded. Abstract screening and data extraction were performed independently by two researchers. Data on the incidence of post-transplant diabetes mellitus (PTDM), change in blood pressure, total cholesterol, and triglycerides, use of antihypertensives and lipid-lowering drugs, were extracted and studied. Results: A total of 23 studies (5,298 participants) comparing SA/ESW with controls under the steroid maintenance protocol were analyzed. PTDM was less likely in the SA/ESW group than in controls (RR=0.61, 95% C.I.= 0.53-0.70, p<0.001). However, insulin-dependent PTDM was not significantly different between the groups. Likewise, patients on SA/ESW group were likely to have lower systolic blood pressure (Hedge’s g= -0.51, 95% C.I.= -1.00, -0.02, p=0.04) and less likely to need antihypertensive treatment (RR=0.61, 95% C.I.=0.46-0.82, p<0.001). SA/ESW group was also likely to have lower total cholesterol (Hedge’s g= -0.41, 95% C.I.= -0.65--0.02, p<0.001), lower triglycerides level (Hedge’s g= -0.46, 95% C.I.= -0.700.22, p<0.001) and lower lipid-lowering drug use (RR=0.75, 95% C.I.= 0.61-0.94, p=0.01) than controls. Conclusions: Steroid-free immunosuppression significantlydecreases the risk of PTDM, systolic hypertension, and dyslipidemia while decreasing the need for anti-hypertensive and lipid-lowering drugs.
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