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  • Steven Skipper posted an update 1 year, 5 months ago

    A total of 3520 participants from 15 RCTs were included. VESW regimen increased the incidence of acute rejection (AR) over controls (RR?=?1.46, CI?=?1.20�C1.79, p?=?0.04). Subsequent analysis demonstrated that such difference lost significance in patients receiving tacrolimus (p?=?0.16), but remained significant in patients with cyclosporin (p?<?0.00001). The increased AR episodes were predominantly mild. VESW was associated with an increased incidence of delayed graft function (DGF) when steroids were withdrawn within three?d post-transplantation. Cardiovascular risk factors, including incidence of new onset diabetes and total cholesterol, were significantly reduced under VESW regimen. It is safe and practical to withdraw steroids very early after renal transplantation. However, a three- to seven-d course of steroids may decrease the risk for DGF relative to steroid withdrawal in <3?d. Antibody induction is effective in preventing early AR. ""Prophylactic use of defibrotide (DF) to prevent veno-occlusive disease (VOD), a relatively common and high-risk complication of hematopoietic stem cell transplantation (HSCT), may be an encouraging modality to reduce morbidity and mortality from VOD. However, conclusions remain unclear. We carried out a systematic review to summarize the state of knowledge. One randomized controlled trial (RCT), four cohort studies and eight case series studies were found, including a total of 1230 patients. The overall mean incidence of VOD in patients using DF was 4.7% (95% CI, 3.3�C6.1) which was significantly lower than the data 13.7% (95% CI, 13.3�C14.1) across 135 studies using no VOD prophylaxis (p?<?0.005). The meta-analysis of the incidence of VOD in controlled trials revealed a statistical reduction in VOD incidence in the DF group (RR?=?0.47, 95% CI, 0.31�C0.73). The overall mean incidence of severe VOD was 0.8% (95% CI, 0.2�C1.4). The RR was 0.31 (95% CI, 0.09�C1.06). However, the lack of RCTs and the methodological weaknesses of the studies may preclude making generalizable conclusions. Our review described that DF appears promising for VOD prevention and large RCT is needed for further confirmation. ""Lorenz EC, Stegall MD, Cosio FG, Gloor JM, Larson TS, Taler SJ. The effect of coronary angiography on renal function in preemptive renal transplant candidates. Clin Transplant 2011: 25: 594�C599. ? 2010 John Wiley & Sons A/S. Abstract:? Background:? Increasing numbers of patients undergo preemptive renal transplantation. Obtaining cardiac catheterizations prior to transplantation to screen for coronary artery disease is controversial because of the perceived risk of inducing contrast nephropathy and the need for dialysis in patients with marginal renal function.