Steroid sparing protocols following nonrenal transplants; the evidence is not there. A systematic review and meta-analysis.

We have recently reported that steroid avoidance or withdrawal (SAW) following renal transplantation results in an increase in acute rejection (AR) rates but does not affect graft or patient survival. Cardiovascular risk factors were significantly reduced. It cannot be assumed that the same risks and benefits apply to nonrenal transplants and we have therefore extended this work to evaluate SAW protocols in nonrenal organ transplantation. A detailed literature search identified nine relevant studies; seven in liver, one in cardiac and one in pancreatic transplant recipients. In liver recipients no difference in AR, graft or patient survival was identified. A significant reduction in the risk of new-onset diabetes was observed with SAW, with trends towards benefits in other cardiovascular risk factors, but meta-analysis was hampered by the small number of studies and significant heterogeneity. Some benefits in cardiovascular risk factors were also identified in the cardiac and pancreatic transplant recipients, but again this evidence is of limited quality. Whilst the trend in effect of SAW in nonrenal recipients appears to be similar to that in renal recipients, the lack of robust evidence requires further randomized controlled trials before the true risk/benefit ratio of SAW in nonrenal transplant recipients can be ascertained.