Evidence map›Paper›PMID 19502970›Full record

ArticleTransplantation2009

Steroid-free immunosuppression in pediatric renal transplantation: rationale for and [corrected] outcomes following conversion to steroid based therapy.

Scott Sutherland, Li Li, Waldo Concepcion, Oscar Salvatierra, Minnie M Sarwal

Erratum issued Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Transplantation, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT01137084 (Liver Transplantation Results in Hepatocellular Carcinoma Patients With Immunosuppression Without Steroids), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
2.8field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01137084 nacompletednot on this map

Liver Transplantation Results in Hepatocellular Carcinoma Patients With Immunosuppression Without Steroids

TypeinterventionalSponsorShanghai Jiao Tong University School of MedicineRan2005 to 2009Enrolled300ConditionsImmunosuppression, Hepatocellular Carcinoma, Liver Transplantation, Post-operative ComplicationsArmssolu medrol, a steroid-free immunosuppression protocol
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.

  1. Pooled it
  2. The clinical impact of humoral immunity in pediatric renal transplantation.Journal of the American Society of Nephrology : JASN · 2013
    Trial
  3. Review
  4. Graft survival of pediatric kidney transplant recipients selected for de novo steroid avoidance-a propensity score-matched study.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2017
    Article
  5. Steroid withdrawal in renal transplantation.Pediatric nephrology (Berlin, Germany) · 2013
    Review
  6. Article
  7. Article
4 · The record

Corrections and comments

  • Erratum issued
5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Scott SutherlandDivision of Nephrology, Department of Pediatrics, Stanford University Medical Center, Stanford, CA 94305, USA. suthersm@stanford.edu
Li Li
Waldo Concepcion
Oscar Salvatierra
Minnie M Sarwal
Stanford Medicine · US

Funding

Defining Biomarkers in Pediatric Renal TransplantationR01AI061739 · NIAID · STANFORD UNIVERSITY · PI SARWAL, MINNIE M · 2004 to 2007
$1.6M
NIAID NIH HHS R01 AI061739NIAID NIH HHS R01 AI 61739-01
6 · The paper itself

Abstract

backgroundShort-term outcomes using steroid-free immunosuppression after renal transplantation have been promising. No studies have examined the incidence of and reasons for steroid-avoidance protocol failures.

methodsWe present a single-center analysis of steroid-free immunosuppression failures among 129 pediatric renal transplant recipients with mean follow-up of 5 years. We analyzed causes for failure and examined reasons for conversion to steroid-based therapy. We compared actual patient and allograft survival and allograft function in the cohort of patients who required conversion to steroid-based immunosuppression with that of the cohort maintaining steroid-free immunosuppression.

resultsA total of 13.2% (17/129) of patients failed steroid-free immunosuppression. Actual patient survival was equivalent in the two cohorts, 96.4% for the cohort maintaining steroid-free immunosuppression and 94.1% for those requiring conversion. Actual allograft survival was lower in patients requiring conversion to a steroid-based protocol, 76.5% vs. 95.5% (P=0.004). Estimated glomerular filtration rates 12-months and 24-months posttransplant were greater in patients maintaining steroid-free immunosuppression (P=0.003). Most patients (52.9%, 9/17) who broke the steroid-free protocol did so because of refractory acute rejection. The second most common reason was recurrence of glomerulonephritis (GN; 35.3%, 6/17).

conclusionThe failure rate of steroid-free immunosuppression among selective pediatric patients undergoing renal transplantation is low. Patients maintaining steroid-free immunosuppression have better allograft survival and function than those requiring conversion to steroid-based therapy. The most common reasons for failure of steroid-free immunosuppression are recalcitrant or recurrent allograft rejection and recurrent GN; the role of conversion to steroid-based immunosuppression after episodes of acute rejection and recurrent GN requires additional analysis.

Indexed as

AdolescentAdrenal Cortex HormonesBiopsyCadaverChildDrug Therapy, CombinationFemaleFollow-Up StudiesGlomerular Filtration RateGlomerulonephritisGraft SurvivalHumansImmunosuppressive AgentsKidney TransplantationLiving DonorsMaleAdrenal Cortex HormonesImmunosuppressive Agents

Identifiers

PMID19502970
PMCPMC2758080
OpenAlexW2398346765

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.