Kidney Week

Abstract: SA-PO009

Corticosteroid Avoidance Among Low Immunologic Risk Adult Renal Transplant Recipients of a Living Donor: A Meta-Analysis

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Estabillo, Amor Patrice Socorro Espinosa, National Kidney and Transplant Institute, East Avenue, Quezon City, QUEZON CITY, Philippines

Amor Patrice Socorro Espinosa Estabillo,

• Limchiu, Luis V., National Kidney and Transplant Institute, East Avenue, Quezon City, QUEZON CITY, Philippines

Luis V. Limchiu,

• Villanueva, Anthony Russell, National Kidney and Transplant Institute, East Avenue, Quezon City, QUEZON CITY, Philippines

Anthony Russell Villanueva,

• Coronel, Marichel Pile, National Kidney and Transplant Institute, Quezon CIty, Metro Manila, Philippines

Marichel Pile Coronel,

Background

Chronic kidney disease is a devastating condition causing global public health burden with high economic cost to health care systems. Renal Transplantation is the standard of care among other forms of renal replacement therapy. Corticosteroids have a critical role, yet its long-term use is associated with a multitude of adverse effects leading to a greater deal of morbidity and mortality post-transplantation. Most researches include heterogenous group of populations: adult and pediatric, low and high immunologic risk recipient of a living or deceased donor. Studies including deceased organ donor population may not be applicable in our local setting since deceased organ donation in some countries are low, mainly due to scarcity of potential donor. Outcome studies on rejection rates may be varied by the immunological-risk status of the donor-recipient pair. Despite the increasing research, corticosteroid sparing following renal transplantation remains a controversial issue, hence the first meta-analysis to focus on a corticosteroid avoidace among low immunologic risk adult renal transplant recipients of a living donor.

Methods

Systematic literature review of the electronic database Cochrane Library, MEDLINE Ovid SP and Clinical Trials.gov were searched for randomized-controlled trials from September-November 2017. Statistical analyses used was random-effects model.

Results

Included 5 studies met the eligibility criteria (N=788). There is no increased risk in the steroid avoidance group having biopsy proven acute rejection at 12 months (RR:0.72[0.51,1.01]) I² 10% p=0.05). A significant reduction towards the risk of New Onset of Diabetes Mellitus After Transplantation (RR:0.41[0.25,0.67]; I²=0% p=0.0003). Likewise, hypertension (RR:0.35[0.12,1.02] I²=82%p=.05) and Infection (RR:0.69[0.46,1.04]; I²=71%p=0.07) was reduced post-transplantation.

Conclusion

Steroid avoidance is non-inferior to maintenance group in terms of biopsy proven acute rejection at 12-months. Metabolic complications and risk of infection were reduced post-transplantation as well.