Han stoppede al immundæmpende medicin, herunder kortison, hos en nyretransplanteret patient seks år efter transplantationen; efter seks uger fungerede den transplanterede nyre mere effektivt med en bedre GFR (fremstillet som en succes for Tayebat-systemet).
Oprindeligt udsagn
هي كلمه واحده انا هقولها معايا حاله زرع ك بطلت لها ادويه مثبطات المناعه بتاعتها الكورتيزون بعد ست سنين من الزرع بتاعها والحمد لله بعد شهر ونص الكليه المزروعه بتعمل بكفاءه اكتر الكليات من احسن والجي اف ار احسن بفضل الله
ordret ifølge kilden. Oversættelse ved projektet; den arabiske ordlyd er gældende.
Oversættelse
Han stoppede al immundæmpende medicin, herunder kortison, hos en nyretransplanteret patient seks år efter transplantationen; efter seks uger fungerede den transplanterede nyre mere effektivt med en bedre GFR (fremstillet som en succes for Tayebat-systemet).
Oprindelse
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! الام الذبحة و التهاب الأعصاب الطرفية (Åbn kilde)
- Offentliggjort
- 18. februar 2025
- Tidsstempel
- 0:18:45 (placering i den originale videos automatiske YouTube-undertekstspor; bekræfter, hvor ordene forekommer, ikke hvem der taler)
- Usikkerhed om tilskrivningen
- Transcript is YouTube CC or machine-generated (no timestamps); wording may contain speech-recognition errors. Speaker attribution within live streams/podcasts is not marked in the transcript; the excerpt was judged to be Elawady's own speech from context. Recurrence = number of archive transcripts matching the keyword pattern ['زرع|زرعه|المزروعه', 'مثبطات|بروجراف|ماي فورتك|ادويه المناعه|دوا الزرع'] (approximate; includes re-uploads/clips; 11 distinct text passages).
- Påstået mekanisme
Not stated in this excerpt.
- Påstået helbredseffekt
Improved function of a transplanted kidney after stopping immunosuppression.
- Berørt befolkningsgruppe
Kidney-transplant recipients.
- Geografisk afgrænsning hos Elawady
none found; he does not limit this statement to a country or to a production system
Afvigende kildeversioner
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- انت نازل الارض تجمع حسنات والا تقضي عقوبه ؟ #ضياء_العوضي #الحقيقة_والسراب (Åbn kilde)
- Offentliggjort
- 16. december 2025
- Tidsstempel
- ikke tilgængeligt (transskriptionen har ingen tidsangivelser)
- Usikkerhed om tilskrivningen
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!لايف الخميس ❤️❤️❤️ (Åbn kilde)
- Offentliggjort
- 30. januar 2026
- Tidsstempel
- ikke tilgængeligt (transskriptionen har ingen tidsangivelser)
- Usikkerhed om tilskrivningen
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!تجويع الخلايا من السكر الكظرية (Åbn kilde)
- Offentliggjort
- 26. oktober 2025
- Tidsstempel
- ikke tilgængeligt (transskriptionen har ingen tidsangivelser)
- Usikkerhed om tilskrivningen
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
Videnskabelig vurdering
Falsk – Udsagnet modsiger den robuste evidens.
Evidensens sikkerhed: moderat – Yderligere forskning kan stadig påvirke vurderingen.
1. Hvad blev der påstået?
He reports that he stopped all immunosuppressants and cortisone in a kidney-transplant recipient six years after transplantation and that six weeks later the graft worked better.
2. Hvad er påviseligt korrekt?
Corticosteroids can be withdrawn in selected recipients when other immunosuppressants continue: in a blinded RCT, early steroid withdrawal with continued tacrolimus and MMF gave similar 5-year graft survival and function and better metabolic outcomes, though with more mild acute rejection (17.8% vs 10.8%) (I-INTB-10). He also said himself that he did not know what would happen. A Cochrane review updated in 2026 (53 trials) found no clear difference in graft loss in the first year when steroids were stopped or avoided while other drugs continued (I-SRC-101). A small number of recipients do keep a working kidney without any drugs (operational tolerance), but this is rare, cannot be predicted by routine tests, and about 30% of such patients in a European cohort later showed slow loss of function (I-SRC-118).
3. Hvad er forkert eller overdrevet?
Presenting this case as a success is not justified. Not taking immunosuppressants is common and is associated with about seven times higher odds of graft failure; a median 36% of graft losses followed prior nonadherence (I-INTB-09). Rejection can develop months after stopping drugs, so six weeks says little. A short-term rise in GFR after stopping calcineurin inhibitors (tacrolimus, ciclosporin) is expected: the KDIGO guideline notes that randomised trials of complete calcineurin-inhibitor withdrawal show some small benefit in graft function but significantly more acute rejection (I-INTB-11), so a better GFR does not prove the graft is safe. In the CTOT-09 trial, stopping tacrolimus even in low-risk recipients led to rejection in 4 of 14 and new donor-specific antibodies in 5 of 14, and the trial was stopped (I-SRC-102). Immunosuppression and graft monitoring are part of standard transplant care (I-INTB-11).
4. Hvad er stadig uklart?
What happened to this patient later is unknown.
5. Hvilke studier understøtter det?
I-INTB-10 and I-SRC-101 (only for steroid withdrawal with continued immunosuppression); I-SRC-118 (rare operational tolerance; selected survivors).
6. Hvilke studier modsiger det?
7. Hvad gælder i Tyskland og Europa?
Transplant centres in Europe follow KDIGO-type guidance; changes in immunosuppression are made by the transplant team.
8. Hvad vides om Egypten?
The same applies in Egypt; graft loss means a return to dialysis.
9. Hvilken praktisk konklusion er passende?
Stop aldrig transplantationsmedicin uden transplantationsteamet. Nedtrapning af steroider er undertiden mulig, men kun under specialisttilsyn med kontrol.
Detaljer om vurderingen
- Begrundelse for evidensens sikkerhed
The single case cannot be verified and six weeks is far too short to judge graft survival. Systematic review evidence shows that not taking immunosuppressants raises the odds of graft failure about sevenfold (I-INTB-09). Complete withdrawal has not been tested in randomised trials (it would be unethical), so certainty is moderate rather than high. Since the last review, a randomised trial (CTOT-09, I-SRC-102) showed that stopping only tacrolimus in carefully selected low-risk recipients caused rejection or new donor-specific antibodies in about a third, and the KDIGO guideline text confirms that RCTs of calcineurin-inhibitor withdrawal show a small gain in graft function but significantly more acute rejection.
- Kildekvalitet
Machine transcript of a live stream; wording may contain recognition errors; meaning checked in context. Anecdote; no medical records shown.
- Regional overførbarhed
Universal transplant immunology.
- Individuelle undtagelser
A small minority of recipients may become tolerant of the graft (general transplant knowledge, not sourced here); this cannot be predicted without specialist testing.
- Påstandens regionale rækkevidde
- generel (biologisk/medicinsk)
- Senest gennemgået
- 26. oktober 2026 foreløbig
Videnskabelig evidens i detaljer
Videnskabeligt afkræftet – Evidens af høj kvalitet viser det modsatte, eller påstanden strider mod veletableret fysiologi.
Forskningsspørgsmål: In kidney-transplant recipients several years after transplantation, does stopping all immunosuppressive drugs (including corticosteroids) preserve or improve graft function compared with continuing maintenance immunosuppression?
Forskningsspørgsmål i detaljer (PICO)
- Population
- Kidney-transplant recipients on maintenance immunosuppression (years after transplantation)
- Intervention eller eksponering
- Withdrawal of all immunosuppressants and corticosteroids (or of single key drugs)
- Sammenligning
- Continued maintenance immunosuppression
- Geografisk rækkevidde
- universal biology; transplant care standards are international and apply in Egypt
- Effektmål
- Acute rejection
- De novo donor-specific antibodies
- Graft loss / return to dialysis
- GFR (short and long term)
Studieresultater som rapporteret af forfatterne. Vores vurdering følger nedenfor.
Hvad taler for påstanden?
A few kidney recipients keep working kidneys without drugs
Brouard S et al.. Am J Transplant 2012 · PMID 22974211 · DOI 10.1111/j.1600-6143.2012.04249.x Caseserie / caserapportabstract kontrolleretnyligt tilføjetA European cohort of 27 kidney recipients who kept working grafts after stopping all immunosuppression.
- Faktisk resultat
- 19 of 27 stable at mean 9 ± 4 years; 30% slowly deteriorated; DSA-associated injury in half of biopsied patients.
- Metodisk kvalitet
- low (selected survivors, no denominator)
- Relevans
- direct for the existence of rare tolerance
- Begrænsninger
- Counts only successes; cannot estimate how often stopping is tolerated.
Stopping steroids after a kidney transplant while other anti-rejection drugs continue
Oliveras L et al.. Cochrane Database Syst Rev 2026 · PMID 42187003 · DOI 10.1002/14651858.CD005632.pub4 Metaanalyseabstract kontrolleretnyligt tilføjetCochrane 2026: steroid withdrawal or avoidance while other drugs continue.
- Faktisk resultat
- Graft loss <=1 y withdrawal RR 1.19 (0.72-1.96); BPAR avoidance RR 1.58 (1.11-2.25); less post-transplant diabetes.
- Metodisk kvalitet
- high (Cochrane, 53 RCTs; low-certainty evidence)
- Relevans
- indirect: only steroids stopped, other drugs continued
- Begrænsninger
- Does not test stopping all drugs.
Hvad taler imod påstanden?
Stopping tacrolimus after kidney transplant caused rejection
Hricik DE et al.. J Am Soc Nephrol 2015 · PMID 25925687 · DOI 10.1681/ASN.2014121234 Randomiseret kontrolleret forsøgabstract kontrolleretnyligt tilføjetCTOT-09 RCT: tacrolimus weaned in carefully selected immunologically quiescent recipients.
- Faktisk resultat
- Stopped early: acute rejection 4/14, de novo DSA 5/14 in the withdrawal arm.
- Metodisk kvalitet
- moderate (randomised, small, stopped early)
- Relevans
- direct: withdrawal of the key drug years-scale after transplant
- Begrænsninger
- Small; one drug withdrawn.
Skipping transplant drugs often leads to losing the kidney
Butler JA et al.. Transplantation 2004 · PMID 15021846 · DOI 10.1097/01.tp.0000110408.83054.88 Metaanalyseabstract kontrolleretSystematic review of non-adherence to immunosuppressants.
- Faktisk resultat
- Non-adherence associated with about sevenfold odds of graft failure; median 36% of graft losses preceded by non-adherence.
- Metodisk kvalitet
- moderate (observational synthesis)
- Relevans
- direct for stopping drugs outside medical supervision
- Begrænsninger
- Observational.
International guideline for kidney-transplant care
KDIGO Transplant Work Group. Am J Transplant 2009 · PMID 19845597 · DOI 10.1111/j.1600-6143.2009.02834.x Retningslinje / holdningspapirabstract kontrolleretKDIGO 2009 transplant guideline (full PDF read for chapter 3).
- Faktisk resultat
- Suggests CNIs and prednisone be continued rather than withdrawn (2B/2C); RCTs of complete CNI withdrawal (8 RCTs, 1891 patients) show a small benefit in graft function but significantly increased acute rejection.
- Metodisk kvalitet
- guideline, GRADE-based
- Relevans
- direct
- Begrænsninger
- 2009; update pending.
Hvad siger den samlede evidens?
Redaktionel vurdering på grundlag af studierne ovenfor – ikke selv et studieresultat.
Hvilken position er bedst underbygget?
Continuing maintenance immunosuppression; only supervised steroid withdrawal in selected patients is supported.
Hvorfor nogle studier vejer tungere
Randomised data (CTOT-09; CNI-withdrawal RCTs summarised by KDIGO; Cochrane steroid review) and the non-adherence synthesis outweigh a single unverified anecdote with six weeks of follow-up. The tolerance cohort shows rare exceptions but counts only survivors.
Er en årsagssammenhæng påvist? Sandsynlig Randomised withdrawal of a single key drug caused rejection and antibody formation; observational data link stopping drugs to graft failure. Complete withdrawal of all drugs has not been randomised (unethical), so causal evidence is from partial withdrawal plus consistent observational data.
Resterende usikkerhed
Long-term outcome of the patient described is unknown; rare operationally tolerant recipients exist but cannot be identified reliably in advance.
Begrundet konklusion
Stopping all immunosuppression is expected to cause rejection and graft loss in most recipients. A rise in GFR shortly after stopping calcineurin inhibitors is a known drug effect (KDIGO: small benefit in graft function with CNI withdrawal) and does not show safety.
Hvorfor ser studierne ud til at være uenige?
Afhænger det af landet?
- Generelle biologiske virkninger
- Transplant immunology is universal.
- Spisevaner
- Not diet-related.
- Fødevarens oprindelse
- Not applicable.
- Forurenende stoffer
- Not applicable.
- Nationale produktionsforhold
- Not applicable.
- Retsregler
- Immunosuppressants are prescription medicines; changes are made by transplant teams in Egypt and Europe.
- Faktiske overvågningsdata
- No Egyptian registry data on withdrawal outcomes found.
En regional forskel, der ændrer konklusionen, er ikke understøttet af robuste data.
Statistisk genberegning
- Wilson 95% CI for event rates in withdrawal arm – Rejection 4/14 = 28.6% (11.7%-54.6%); DSA 5/14 = 35.7% (16.3%-61.2%) genberegnet
- Log-symmetry of RR CIs (RR vs OR wording correct: Cochrane reports RR) – Geometric midpoints equal reported RRs (1.58, 1.41, 1.19, 0.61); consistent genberegnet
Sikkerheden af den samlede evidens (GRADE, forenklet)
- Primært effektmål
- Graft rejection/loss after withdrawal of maintenance immunosuppression
- Udgangsniveau
- høj (randomiserede forsøg)
- Grunde til nedgradering
- indirectness: complete withdrawal of all drugs not randomised; evidence from single-drug withdrawal
- imprecision: small CTOT-09 arm
- Grunde til opgradering
- large effect (sevenfold odds of graft failure with non-adherence; trial stopped for harm)
- Resultat
- moderat
Forenklet vurdering ved én bedømmer efter GRADE-tilgangen; ikke et formelt GRADE-panel. GRADE vurderer den samlede evidens for ét effektmål, ikke enkelte studier.
Kontrollerede kliniske retningslinjer og officielle udtalelser
- KDIGO: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients (2009) · Original publikation
Rec. 3.2: suggest that CNIs be continued rather than withdrawn (2B) and that prednisone used beyond the first week be continued rather than withdrawn (2C). Background: RCTs of complete CNI withdrawal (8 RCTs, 1891 patients) show some small benefit in graft function but significantly increased acute rejection without clear graft-survival benefit; steroid withdrawal more than 3 months after transplantation increases acute rejection. - KDIGO: Guideline landing page (Care of Kidney Transplant Recipients) (2009) · Original publikation
Confirms the 2009 guideline is the current KDIGO transplant-recipient guideline listed; no update text on the page.
Søgestrategi
Dokumenterede litteratursøgninger til denne gennemgang (søgestrenge i databasens originale syntaks).
| Database | Dato | Søgning | Søgt efter | Hits | Inkluderet |
|---|---|---|---|---|---|
| Europe PMC | 26. oktober 2026 | ("operational tolerance" OR "spontaneous tolerance") AND kidney transplant AND (immunosuppression withdrawal OR "drug-free") | understøttende evidens | 709 | |
| Europe PMC | 26. oktober 2026 | (immunosuppression withdrawal OR "tacrolimus withdrawal" OR "calcineurin inhibitor withdrawal") AND kidney transplant AND (rejection OR "donor-specific antibod*") AND (randomized OR trial) | modsigende evidens | 12115 | |
| Europe PMC | 26. oktober 2026 | (steroid withdrawal OR steroid avoidance) AND kidney transplant AND "Cochrane Database Syst Rev" | begge retninger | 146 | |
| PubMed | 26. oktober 2026 | tacrolimus withdrawal immune quiescent kidney transplant | modsigende evidens | 1 | |
| PubMed | 26. oktober 2026 | operationally tolerant kidney transplant recipients immunosuppression discontinuation cohort | understøttende evidens | 0 | |
| Europe PMC | 26. oktober 2026 | TITLE:"operationally tolerant" AND kidney | understøttende evidens | 8 | |
| Europe PMC | 26. oktober 2026 | (nonadherence OR non-adherence) AND immunosuppress* AND kidney transplant AND (graft loss OR graft failure) AND (cohort OR systematic review) AND PUB_YEAR:[2015 TO 2026] | modsigende evidens | 3309 | |
| PubMed | 26. oktober 2026 | natural history of clinical operational tolerance after kidney transplantation | understøttende evidens | 5 | |
| KDIGO website | 26. oktober 2026 | https://kdigo.org/guidelines/transplant-recipient/ (guideline page and full PDF) | retningslinjer | 1 | |
| Europe PMC | 26. oktober 2026 | kidney transplant AND "operational tolerance" AND (prevalence OR "natural history" OR registry) | understøttende evidens | 178 |
Åbne spørgsmål
Biomarkers that could identify the rare operationally tolerant recipient.
Hvor grundigt blev dette kontrolleret?
6 tilknyttede studier: 0 kontrolleret i fuldtekst (heraf 0 med en struktureret vurdering af risiko for bias), 6 på grundlag af abstractet, 0 kun bibliografisk. Der har endnu ikke fundet en formel vurdering med to uafhængige bedømmere sted, og heller ingen uafhængig menneskelig ekspertgennemgang.
Seneste videnskabelige gennemgang: 26. oktober 2026
Vurderingens historik
- 25. oktober 2026 · Fase 1 · Første vurdering: Falsk (moderat)
- 26. oktober 2026 · Fase 4 (systematisk evidensgennemgang) · Undersøgt igen med udvidet evidens; vurdering uændret: Falsk (moderat)
New randomised (CTOT-09) and Cochrane 2026 evidence and the KDIGO full text strengthen the existing verdict and explain the reported GFR rise as a known CNI-withdrawal effect. Complete withdrawal has still not been randomised, so certainty stays moderate.
Nye kilder: I-SRC-101 I-SRC-102 I-SRC-118
På almindeligt sprog
Dr. Elawady beskrev en nyretransplanteret patient, hvis afstødningshæmmende medicin han stoppede, og sagde, at nyren fungerede bedre seks uger senere. Ét enkelt tilfælde kan ikke efterprøves, og seks uger er alt for kort tid. Studier viser, at personer, der ikke tager deres afstødningshæmmende medicin, har langt større risiko for at miste den nye nyre. Læger kan undertiden stoppe kortison, men kun mens anden afstødningshæmmende medicin fortsætter. Det er risikabelt at stoppe al medicin.
Studier om denne påstand
Studier, der understøtter påstanden (0)
Ingen studier i denne gruppe.
Studier, der modsiger eller begrænser påstanden (3)
-
Skipping transplant drugs often leads to losing the kidney
Butler JA et al.. Transplantation 2004 · PMID 15021846 · DOI 10.1097/01.tp.0000110408.83054.88Metaanalyseuafhængig krydstjekabstract kontrolleret★ nøglestudieNot taking immunosuppressants was linked to about seven times higher odds of graft failure.
Nonadherence raises graft failure about sevenfold.
Understøtter studiet den konkrete påstand? Nej · Metodisk kvalitet: moderat · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Measure impact of nonadherence
- Hvordan blev studiet udført?
Systematic review
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
36 studies
- Hvad blev der faktisk fundet?
Nonadherence common; strongly linked to graft loss
- Hvor stor var den observerede effekt?
about 7-fold odds of graft failure
- Hvad betyder resultaterne i hverdagen?
Transplant medicines protect the new kidney; stopping them is a major cause of losing it.
- Hvilke begrænsninger har studiet?
Self-report measures; abstract only
- Hvad siger det om Elawadys konkrete påstand?
Contradicts stopping immunosuppression.
- Gælder resultaterne for Tyskland og Europa?
High
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Cannot predict the outcome for one individual patient.
-
International guideline for kidney-transplant care
KDIGO Transplant Work Group. Am J Transplant 2009 · PMID 19845597 · DOI 10.1111/j.1600-6143.2009.02834.xRetningslinje / holdningspapiruafhængig krydstjekabstract kontrolleretGives recommendations on immunosuppression and monitoring after kidney transplant.
Immunosuppression is part of standard care.
Understøtter studiet den konkrete påstand? Nej · Metodisk kvalitet: moderat · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Guide transplant care
- Hvordan blev studiet udført?
GRADE guideline
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
not applicable
- Hvad blev der faktisk fundet?
Recommendations on immunosuppression
- Hvor stor var den observerede effekt?
not applicable
- Hvad betyder resultaterne i hverdagen?
Anti-rejection treatment and monitoring are standard after a kidney transplant.
- Hvilke begrænsninger har studiet?
Abstract only
- Hvad siger det om Elawadys konkrete påstand?
Contradicts stopping all immunosuppression.
- Gælder resultaterne for Tyskland og Europa?
High
-
Stopping tacrolimus after kidney transplant caused rejection
Hricik DE et al.. J Am Soc Nephrol 2015 · PMID 25925687 · DOI 10.1681/ASN.2014121234Randomiseret kontrolleret forsøguafhængig krydstjekabstract kontrolleret★ nøglestudieIn a trial of carefully selected low-risk patients, stopping tacrolimus led to rejection in 4 of 14 and new antibodies in 5 of 14; the trial was stopped.
Withdrawal of only tacrolimus in lowest-risk patients caused rejection or antibodies in about a third.
Understøtter studiet den konkrete påstand? Nej · Metodisk kvalitet: moderat · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Test whether low-risk kidney recipients can stop tacrolimus
- Hvordan blev studiet udført?
Randomised trial
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
Living-donor recipients; 14 in the withdrawal arm
- Hvad blev der faktisk fundet?
High rates of rejection and donor-specific antibodies
- Hvor stor var den observerede effekt?
4/14 rejection; 5/14 new antibodies
- Hvad betyder resultaterne i hverdagen?
Even stopping one anti-rejection drug can damage the kidney
- Hvilke begrænsninger har studiet?
Small; stopped early
- Hvad siger det om Elawadys konkrete påstand?
Contradicts stopping all immunosuppression
- Gælder resultaterne for Tyskland og Europa?
High
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Long-term graft loss rates (trial stopped)
Intet studie i denne gruppe er markeret som nøglestudie.
Studier med blandede eller uklare resultater (3)
-
Stopping steroids early after transplant, while keeping other drugs
Woodle ES et al.. Ann Surg 2008 · PMID 18936569 · DOI 10.1097/SLA.0b013e318187d1daRandomiseret kontrolleret forsøguafhængig krydstjekabstract kontrolleretWith continued tacrolimus and MMF, early steroid withdrawal gave similar 5-year graft survival but more mild rejection.
Steroid withdrawal possible with continued immunosuppression.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Test early steroid withdrawal
- Hvordan blev studiet udført?
Blinded RCT
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
386 recipients
- Hvad blev der faktisk fundet?
Similar graft survival; more mild rejection; better metabolic profile
- Hvor stor var den observerede effekt?
rejection 17.8% vs 10.8%
- Hvad betyder resultaterne i hverdagen?
Doctors can sometimes drop cortisone after transplant, but the other anti-rejection drugs stay.
- Hvilke begrænsninger har studiet?
Selected patients; abstract only
- Hvad siger det om Elawadys konkrete påstand?
Partly supports dropping cortisone; contradicts stopping all immunosuppressants.
- Gælder resultaterne for Tyskland og Europa?
High
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Cannot conclude that all immunosuppression can be stopped.
-
Stopping steroids after a kidney transplant while other anti-rejection drugs continue
Oliveras L et al.. Cochrane Database Syst Rev 2026 · PMID 42187003 · DOI 10.1002/14651858.CD005632.pub4Metaanalyseuafhængig krydstjekabstract kontrolleret★ nøglestudieAcross 53 trials, stopping or avoiding steroids did not clearly change graft loss in the first year; avoiding steroids slightly raised acute rejection in some regimens.
Supports steroid withdrawal only when other immunosuppressants continue; does not support stopping all drugs.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Find out whether steroids can be left out after a kidney transplant
- Hvordan blev studiet udført?
Cochrane review of randomised trials
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
53 trials, 8317 recipients
- Hvad blev der faktisk fundet?
Similar short-term graft survival; more acute rejection with steroid avoidance unless combined with modern drugs; less post-transplant diabetes
- Hvor stor var den observerede effekt?
BPAR RR 1.58 (avoidance); graft loss RR 1.19 (withdrawal, CI 0.72-1.96)
- Hvad betyder resultaterne i hverdagen?
Doctors can sometimes stop cortisone, but only while other anti-rejection drugs continue
- Hvilke begrænsninger har studiet?
Low certainty; mostly unblinded trials
- Hvad siger det om Elawadys konkrete påstand?
Supports only steroid withdrawal under specialist care, not stopping all drugs
- Gælder resultaterne for Tyskland og Europa?
High
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Whether stopping all anti-rejection drugs is safe (not studied)
-
A few kidney recipients keep working kidneys without drugs
Brouard S et al.. Am J Transplant 2012 · PMID 22974211 · DOI 10.1111/j.1600-6143.2012.04249.xCaseserie / caserapportuafhængig krydstjekabstract kontrolleret27 rare patients had stable kidneys off drugs, but almost a third later lost function slowly.
Rare operational tolerance exists, but the cohort counts only successes and 30% later deteriorated.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: lav · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Describe patients who tolerate a kidney without drugs
- Hvordan blev studiet udført?
Comparison of a rare cohort with other patients
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
27 tolerant patients
- Hvad blev der faktisk fundet?
Most kept function for years; 30% slowly deteriorated
- Hvor stor var den observerede effekt?
19/27 stable at mean 9 years
- Hvad betyder resultaterne i hverdagen?
Such cases exist but are rare and cannot be predicted
- Hvilke begrænsninger har studiet?
Only successes counted
- Hvad siger det om Elawadys konkrete påstand?
A rare exception, not a basis for stopping drugs
- Gælder resultaterne for Tyskland og Europa?
European data
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
How many people who stop drugs keep their kidney
Intet studie i denne gruppe er markeret som nøglestudie.
Regional kontekst
Tyskland / EU
Transplant centres in Europe follow KDIGO-type guidance; changes in immunosuppression are made by the transplant team.
Egypten
The same applies in Egypt; graft loss means a return to dialysis.
Hvad gælder i mit land?
Generel videnskabelig vurdering
Falsk At stoppe al afstødningshæmmende medicin efter en nyretransplantation er ikke en succes: forsøg viser, at selv det at stoppe ét centralt lægemiddel fører til afstødning, og en kortsigtet stigning i GFR er en forventet lægemiddelvirkning.
Dette udsagn vedrører biologiske eller medicinske sammenhænge. Den videnskabelige vurdering ovenfor gælder uanset land; landespecifikke fødevaredata ændrer ikke ved den.
Referencer
- Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review.. Butler JA et al.. Transplantation 2004 · PMID 15021846 · DOI 10.1097/01.tp.0000110408.83054.88
- KDIGO clinical practice guideline for the care of kidney transplant recipients.. KDIGO Transplant Work Group. Am J Transplant 2009 · PMID 19845597 · DOI 10.1111/j.1600-6143.2009.02834.x
- Adverse Outcomes of Tacrolimus Withdrawal in Immune-Quiescent Kidney Transplant Recipients.. Hricik DE et al.. J Am Soc Nephrol 2015 · PMID 25925687 · DOI 10.1681/ASN.2014121234
- A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.. Woodle ES et al.. Ann Surg 2008 · PMID 18936569 · DOI 10.1097/SLA.0b013e318187d1da
- Steroid avoidance or withdrawal for kidney transplant recipients.. Oliveras L et al.. Cochrane Database Syst Rev 2026 · PMID 42187003 · DOI 10.1002/14651858.CD005632.pub4
- The natural history of clinical operational tolerance after kidney transplantation through twenty-seven cases.. Brouard S et al.. Am J Transplant 2012 · PMID 22974211 · DOI 10.1111/j.1600-6143.2012.04249.x