title: Steroid Avoidance or Withdrawal Regimens in Paediatric Kidney Transplantation: A Meta-Analysis of Randomised Controlled Trials.
abstract: BACKGROUND
  We combined the outcomes of all randomised controlled trials to investigate the safety and efficacy of steroid avoidance or withdrawal (SAW) regimens in paediatric kidney transplantation compared with steroid-based (SB) regimens.
  
  
  METHODS
  A systematic literature search of PubMed, Embase, Cochrane Library, the trials registry and BIOSIS previews was performed. A change in the height standardised Z-score from baseline (ΔHSDS) and acute rejection were the primary endpoints.
  
  
  RESULTS
  Eight reports from 5 randomised controlled trials were included, with a total of 528 patients. Sufficient evidence of a significant increase in the ΔHSDS was observed in the SAW group (mean difference (MD) = 0.38, 95% confidence interval (CI) 0.07-0.68, P = 0.01), particularly within the first year post-withdrawal (MD = 0.22, 95% CI 0.10-0.35, P = 0.0003) and in the prepubertal recipients (MD = 0.60, 95% CI 0.21-0.98, P = 0.002). There was no significant difference in the risk of acute rejection between the groups (relative risk = 1.04, 95% CI 0.80-1.36, P = 0.77).
  
  
  CONCLUSIONS
  The SAW regimen is justified in select paediatric renal allograft recipients because it provides significant benefits in post-transplant growth within the first year post-withdrawal with minimal effects on the risk of acute rejection, graft function, and graft and patient survival within 3 years post-withdrawal. These select paediatric recipients should have the following characteristics: prepubertal; Caucasian; with primary disease not related to immunological factors; de novo kidney transplant recipient; with low panel reactive antibody.
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Huanxi
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yitao
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Longshan
authors.initials: L
authors.lastname: Liu
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Fu
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Medical Information Institute, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Qingshan
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Neurology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Huijiao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Ronghai
authors.initials: R
authors.lastname: Deng
authors.affiliation: Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Changxi
authors.initials: C
authors.lastname: Wang
mesh_terms: D002648:Child; D006801:Humans; D016030:Kidney Transplantation; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D013256:Steroids