Steroid-free immunosuppression in cyclosporine-treated renal transplant recipients: a meta-analysis

Data from seven randomized, prospective trials were pooled to determine the effect of steroid-free immunosuppression on allograft survival, patient survival, and the incidence of acute allograft rejection in renal transplant recipients receiving cyclosporine-based maintenance immunosuppression. Six of the seven trials incorporated into this analysis examined the effects of either complete avoidance of steroids or withdrawal of steroids less than 3 months after transplantation. Only one of the studies estimated patient and graft survival beyond 2 yr. Results of the meta-analysis suggest that avoiding steroid therapy from the time of transplantation or withdrawing steroid therapy at some time after transplantation increases the risk of acute allograft rejection without adversely affecting patient or graft survival. However, these results may not accurately reflect the risk of acute allograft rejection in patients subjected to later withdrawal of steroids. Longer periods of follow-up are required to assess the risk of chronic rejection in cyclosporine-treated renal transplant recipients who are not receiving steroids.