Ia menghentikan semua obat imunosupresan, termasuk kortison, pada seorang pasien transplantasi ginjal enam tahun setelah transplantasi; setelah enam minggu, ginjal cangkok bekerja lebih efisien dengan GFR yang lebih baik (disajikan sebagai keberhasilan sistem Tayebat).
Pernyataan asli
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
kata demi kata sesuai sumber. Terjemahan oleh proyek; rumusan bahasa Arab yang menjadi acuan.
Terjemahan
Ia menghentikan semua obat imunosupresan, termasuk kortison, pada seorang pasien transplantasi ginjal enam tahun setelah transplantasi; setelah enam minggu, ginjal cangkok bekerja lebih efisien dengan GFR yang lebih baik (disajikan sebagai keberhasilan sistem Tayebat).
Asal
- Status sumber
- Transkrip video (kata-katanya sendiri)
- Atribusi
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! الام الذبحة و التهاب الأعصاب الطرفية (Buka sumber)
- Dipublikasikan
- 18 Februari 2025
- Penanda waktu
- 0:18:45 (lokasi dalam trek takarir otomatis YouTube dari video asli; memastikan di mana kata-kata itu muncul, bukan siapa yang berbicara)
- Ketidakpastian atribusi
- 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).
- Mekanisme yang diklaim
Not stated in this excerpt.
- Efek kesehatan yang diklaim
Improved function of a transplanted kidney after stopping immunosuppression.
- Populasi yang dimaksud
Kidney-transplant recipients.
- Batasan geografis oleh Elawady
none found; he does not limit this statement to a country or to a production system
Versi sumber yang berbeda
- Status sumber
- Transkrip video (kata-katanya sendiri)
- Atribusi
- Elawady (machine transcript)
- Video
- انت نازل الارض تجمع حسنات والا تقضي عقوبه ؟ #ضياء_العوضي #الحقيقة_والسراب (Buka sumber)
- Dipublikasikan
- 16 Desember 2025
- Penanda waktu
- tidak tersedia (transkrip tidak memiliki penanda waktu)
- Ketidakpastian atribusi
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
- Status sumber
- Transkrip video (kata-katanya sendiri)
- Atribusi
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!لايف الخميس ❤️❤️❤️ (Buka sumber)
- Dipublikasikan
- 30 Januari 2026
- Penanda waktu
- tidak tersedia (transkrip tidak memiliki penanda waktu)
- Ketidakpastian atribusi
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
- Status sumber
- Transkrip video (kata-katanya sendiri)
- Atribusi
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!تجويع الخلايا من السكر الكظرية (Buka sumber)
- Dipublikasikan
- 26 Oktober 2025
- Penanda waktu
- tidak tersedia (transkrip tidak memiliki penanda waktu)
- Ketidakpastian atribusi
- Further video in which the same statement recurs; no excerpt recorded. Archive transcript without timestamps.
Penilaian ilmiah
Salah – Pernyataan ini bertentangan dengan bukti yang kuat.
Tingkat kepastian bukti: sedang – Penelitian lebih lanjut masih dapat memengaruhi penilaian.
1. Apa yang diklaim?
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. Apa yang terbukti benar?
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. Apa yang salah atau dilebih-lebihkan?
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. Apa yang masih belum jelas?
What happened to this patient later is unknown.
5. Studi mana yang mendukungnya?
I-INTB-10 and I-SRC-101 (only for steroid withdrawal with continued immunosuppression); I-SRC-118 (rare operational tolerance; selected survivors).
6. Studi mana yang membantahnya?
7. Apa yang berlaku untuk Jerman dan Eropa?
Transplant centres in Europe follow KDIGO-type guidance; changes in immunosuppression are made by the transplant team.
8. Apa yang diketahui tentang Mesir?
The same applies in Egypt; graft loss means a return to dialysis.
9. Kesimpulan praktis apa yang tepat?
Jangan pernah menghentikan obat transplantasi tanpa tim transplantasi. Pengurangan steroid kadang-kadang mungkin dilakukan, tetapi hanya di bawah pengawasan spesialis disertai pemantauan.
Rincian penilaian
- Alasan tingkat kepastian bukti
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.
- Kualitas sumber
Machine transcript of a live stream; wording may contain recognition errors; meaning checked in context. Anecdote; no medical records shown.
- Keteralihan ke wilayah lain
Universal transplant immunology.
- Pengecualian individual
A small minority of recipients may become tolerant of the graft (general transplant knowledge, not sourced here); this cannot be predicted without specialist testing.
- Cakupan wilayah klaim
- umum (biologis/medis)
- Terakhir ditinjau
- 26 Oktober 2026 sementara
Bukti ilmiah secara rinci
Terbantah secara ilmiah – Bukti berkualitas tinggi menunjukkan hal sebaliknya, atau klaim ini bertentangan dengan fisiologi yang sudah mapan.
Pertanyaan penelitian: 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?
Pertanyaan penelitian secara rinci (PICO)
- Populasi
- Kidney-transplant recipients on maintenance immunosuppression (years after transplantation)
- Intervensi atau paparan
- Withdrawal of all immunosuppressants and corticosteroids (or of single key drugs)
- Pembanding
- Continued maintenance immunosuppression
- Cakupan geografis
- universal biology; transplant care standards are international and apply in Egypt
- Luaran
- Acute rejection
- De novo donor-specific antibodies
- Graft loss / return to dialysis
- GFR (short and long term)
Hasil studi sebagaimana dilaporkan oleh para penulis. Penilaian kami menyusul di bawah.
Apa yang mendukung klaim ini?
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 Serial kasus / laporan kasusabstrak diperiksabaru ditambahkanA European cohort of 27 kidney recipients who kept working grafts after stopping all immunosuppression.
- Hasil sebenarnya
- 19 of 27 stable at mean 9 ± 4 years; 30% slowly deteriorated; DSA-associated injury in half of biopsied patients.
- Kualitas metodologis
- low (selected survivors, no denominator)
- Relevansi
- direct for the existence of rare tolerance
- Keterbatasan
- 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 Meta-analisisabstrak diperiksabaru ditambahkanCochrane 2026: steroid withdrawal or avoidance while other drugs continue.
- Hasil sebenarnya
- 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.
- Kualitas metodologis
- high (Cochrane, 53 RCTs; low-certainty evidence)
- Relevansi
- indirect: only steroids stopped, other drugs continued
- Keterbatasan
- Does not test stopping all drugs.
Apa yang menentang klaim ini?
Stopping tacrolimus after kidney transplant caused rejection
Hricik DE et al.. J Am Soc Nephrol 2015 · PMID 25925687 · DOI 10.1681/ASN.2014121234 Uji acak terkendaliabstrak diperiksabaru ditambahkanCTOT-09 RCT: tacrolimus weaned in carefully selected immunologically quiescent recipients.
- Hasil sebenarnya
- Stopped early: acute rejection 4/14, de novo DSA 5/14 in the withdrawal arm.
- Kualitas metodologis
- moderate (randomised, small, stopped early)
- Relevansi
- direct: withdrawal of the key drug years-scale after transplant
- Keterbatasan
- 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 Meta-analisisabstrak diperiksaSystematic review of non-adherence to immunosuppressants.
- Hasil sebenarnya
- Non-adherence associated with about sevenfold odds of graft failure; median 36% of graft losses preceded by non-adherence.
- Kualitas metodologis
- moderate (observational synthesis)
- Relevansi
- direct for stopping drugs outside medical supervision
- Keterbatasan
- 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 Pedoman / pernyataan sikapabstrak diperiksaKDIGO 2009 transplant guideline (full PDF read for chapter 3).
- Hasil sebenarnya
- 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.
- Kualitas metodologis
- guideline, GRADE-based
- Relevansi
- direct
- Keterbatasan
- 2009; update pending.
Apa kata bukti secara keseluruhan?
Penilaian redaksi berdasarkan studi di atas – bukan hasil studi itu sendiri.
Posisi mana yang lebih didukung?
Continuing maintenance immunosuppression; only supervised steroid withdrawal in selected patients is supported.
Mengapa sebagian studi lebih berbobot
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.
Apakah hubungan sebab-akibat sudah terbukti? Kemungkinan besar 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.
Ketidakpastian yang tersisa
Long-term outcome of the patient described is unknown; rare operationally tolerant recipients exist but cannot be identified reliably in advance.
Kesimpulan yang dapat dibenarkan
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.
Mengapa studi-studi tampak saling bertentangan?
Apakah ini bergantung pada negara?
- Efek biologis umum
- Transplant immunology is universal.
- Kebiasaan makan
- Not diet-related.
- Asal makanan
- Not applicable.
- Cemaran
- Not applicable.
- Kondisi produksi nasional
- Not applicable.
- Aturan hukum
- Immunosuppressants are prescription medicines; changes are made by transplant teams in Egypt and Europe.
- Data pemantauan sebenarnya
- No Egyptian registry data on withdrawal outcomes found.
Perbedaan antarwilayah yang mengubah kesimpulan tidak didukung oleh data yang kuat.
Pemeriksaan ulang statistik
- 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%) dihitung ulang
- 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 dihitung ulang
Kepastian bukti secara keseluruhan (GRADE, disederhanakan)
- Luaran utama
- Graft rejection/loss after withdrawal of maintenance immunosuppression
- Tingkat awal
- tinggi (uji acak)
- Alasan penurunan tingkat
- indirectness: complete withdrawal of all drugs not randomised; evidence from single-drug withdrawal
- imprecision: small CTOT-09 arm
- Alasan peningkatan tingkat
- large effect (sevenfold odds of graft failure with non-adherence; trial stopped for harm)
- Hasil
- sedang
Penilaian sederhana oleh satu penilai, mengikuti pendekatan GRADE; bukan panel GRADE formal. GRADE menilai kumpulan bukti untuk satu luaran, bukan studi individual.
Pedoman klinis dan pernyataan resmi yang diperiksa
- KDIGO: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients (2009) · Publikasi asli
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) · Publikasi asli
Confirms the 2009 guideline is the current KDIGO transplant-recipient guideline listed; no update text on the page.
Strategi penelusuran
Penelusuran literatur yang terdokumentasi untuk tinjauan ini (string pencarian dalam sintaksis asli basis data).
| Basis data | Tanggal | Penelusuran | Mencari | Hasil | Disertakan |
|---|---|---|---|---|---|
| Europe PMC | 26 Oktober 2026 | ("operational tolerance" OR "spontaneous tolerance") AND kidney transplant AND (immunosuppression withdrawal OR "drug-free") | bukti pendukung | 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) | bukti yang menentang | 12115 | |
| Europe PMC | 26 Oktober 2026 | (steroid withdrawal OR steroid avoidance) AND kidney transplant AND "Cochrane Database Syst Rev" | kedua arah | 146 | |
| PubMed | 26 Oktober 2026 | tacrolimus withdrawal immune quiescent kidney transplant | bukti yang menentang | 1 | |
| PubMed | 26 Oktober 2026 | operationally tolerant kidney transplant recipients immunosuppression discontinuation cohort | bukti pendukung | 0 | |
| Europe PMC | 26 Oktober 2026 | TITLE:"operationally tolerant" AND kidney | bukti pendukung | 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] | bukti yang menentang | 3309 | |
| PubMed | 26 Oktober 2026 | natural history of clinical operational tolerance after kidney transplantation | bukti pendukung | 5 | |
| KDIGO website | 26 Oktober 2026 | https://kdigo.org/guidelines/transplant-recipient/ (guideline page and full PDF) | pedoman | 1 | |
| Europe PMC | 26 Oktober 2026 | kidney transplant AND "operational tolerance" AND (prevalence OR "natural history" OR registry) | bukti pendukung | 178 |
Pertanyaan terbuka
Biomarkers that could identify the rare operationally tolerant recipient.
Seberapa mendalam ini diperiksa?
6 studi terkait: 0 diperiksa dalam teks lengkap (0 di antaranya dengan penilaian risiko bias terstruktur), 6 berdasarkan abstrak, 0 hanya secara bibliografis. Belum ada penilaian formal oleh dua penilai independen dan belum ada tinjauan pakar manusia yang independen.
Tinjauan ilmiah terakhir: 26 Oktober 2026
Riwayat penilaian
- 25 Oktober 2026 · Fase 1 · Penilaian awal: Salah (sedang)
- 26 Oktober 2026 · Fase 4 (tinjauan bukti sistematis) · Diperiksa ulang dengan bukti yang diperluas; penilaian tidak berubah: Salah (sedang)
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.
Sumber baru: I-SRC-101 I-SRC-102 I-SRC-118
Dalam bahasa sederhana
Dr. Elawady menggambarkan seorang pasien transplantasi ginjal yang obat antipenolakannya ia hentikan, dan mengatakan bahwa ginjal itu bekerja lebih baik enam minggu kemudian. Satu kasus tidak dapat diperiksa kebenarannya dan enam minggu terlalu singkat. Studi menunjukkan bahwa orang yang tidak minum obat antipenolakan jauh lebih mungkin kehilangan ginjal barunya. Dokter kadang-kadang dapat menghentikan kortison, tetapi hanya selama obat antipenolakan lainnya tetap dilanjutkan. Menghentikan semuanya berisiko.
Studi tentang klaim ini
Studi yang mendukung klaim (0)
Tidak ada studi dalam kelompok ini.
Studi yang membantah atau membatasi klaim (3)
-
Skipping transplant drugs often leads to losing the kidney
Butler JA et al.. Transplantation 2004 · PMID 15021846 · DOI 10.1097/01.tp.0000110408.83054.88Meta-analisispemeriksaan silang independenabstrak diperiksa★ studi kunciNot taking immunosuppressants was linked to about seven times higher odds of graft failure.
Nonadherence raises graft failure about sevenfold.
Apakah studi ini mendukung klaim spesifik tersebut? Tidak · Kualitas metodologis: sedang · Tingkat kepastian bukti: lihat penilaian keseluruhan atas klaim
Publikasi asli · Rincian ilmiah
Penjelasan studi secara sederhana
- Apa yang ingin diketahui para peneliti?
Measure impact of nonadherence
- Bagaimana studi ini dilakukan?
Systematic review
- Berapa banyak orang, hewan, atau sampel yang diteliti?
36 studies
- Apa yang sebenarnya ditemukan?
Nonadherence common; strongly linked to graft loss
- Seberapa besar efek yang teramati?
about 7-fold odds of graft failure
- Apa arti hasilnya dalam kehidupan sehari-hari?
Transplant medicines protect the new kidney; stopping them is a major cause of losing it.
- Apa keterbatasan studi ini?
Self-report measures; abstract only
- Apa yang dikatakannya tentang klaim spesifik Elawady?
Contradicts stopping immunosuppression.
- Apakah hasilnya berlaku untuk Jerman dan Eropa?
High
- Apa yang secara tegas tidak dapat disimpulkan dari studi ini?
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.xPedoman / pernyataan sikappemeriksaan silang independenabstrak diperiksaGives recommendations on immunosuppression and monitoring after kidney transplant.
Immunosuppression is part of standard care.
Apakah studi ini mendukung klaim spesifik tersebut? Tidak · Kualitas metodologis: sedang · Tingkat kepastian bukti: lihat penilaian keseluruhan atas klaim
Publikasi asli · Rincian ilmiah
Penjelasan studi secara sederhana
- Apa yang ingin diketahui para peneliti?
Guide transplant care
- Bagaimana studi ini dilakukan?
GRADE guideline
- Berapa banyak orang, hewan, atau sampel yang diteliti?
not applicable
- Apa yang sebenarnya ditemukan?
Recommendations on immunosuppression
- Seberapa besar efek yang teramati?
not applicable
- Apa arti hasilnya dalam kehidupan sehari-hari?
Anti-rejection treatment and monitoring are standard after a kidney transplant.
- Apa keterbatasan studi ini?
Abstract only
- Apa yang dikatakannya tentang klaim spesifik Elawady?
Contradicts stopping all immunosuppression.
- Apakah hasilnya berlaku untuk Jerman dan Eropa?
High
-
Stopping tacrolimus after kidney transplant caused rejection
Hricik DE et al.. J Am Soc Nephrol 2015 · PMID 25925687 · DOI 10.1681/ASN.2014121234Uji acak terkendalipemeriksaan silang independenabstrak diperiksa★ studi kunciIn 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.
Apakah studi ini mendukung klaim spesifik tersebut? Tidak · Kualitas metodologis: sedang · Tingkat kepastian bukti: lihat penilaian keseluruhan atas klaim
Publikasi asli · Rincian ilmiah
Penjelasan studi secara sederhana
- Apa yang ingin diketahui para peneliti?
Test whether low-risk kidney recipients can stop tacrolimus
- Bagaimana studi ini dilakukan?
Randomised trial
- Berapa banyak orang, hewan, atau sampel yang diteliti?
Living-donor recipients; 14 in the withdrawal arm
- Apa yang sebenarnya ditemukan?
High rates of rejection and donor-specific antibodies
- Seberapa besar efek yang teramati?
4/14 rejection; 5/14 new antibodies
- Apa arti hasilnya dalam kehidupan sehari-hari?
Even stopping one anti-rejection drug can damage the kidney
- Apa keterbatasan studi ini?
Small; stopped early
- Apa yang dikatakannya tentang klaim spesifik Elawady?
Contradicts stopping all immunosuppression
- Apakah hasilnya berlaku untuk Jerman dan Eropa?
High
- Apa yang secara tegas tidak dapat disimpulkan dari studi ini?
Long-term graft loss rates (trial stopped)
Tidak ada studi dalam kelompok ini yang ditandai sebagai studi kunci.
Studi dengan hasil campuran atau tidak jelas (3)
-
Stopping steroids early after transplant, while keeping other drugs
Woodle ES et al.. Ann Surg 2008 · PMID 18936569 · DOI 10.1097/SLA.0b013e318187d1daUji acak terkendalipemeriksaan silang independenabstrak diperiksaWith continued tacrolimus and MMF, early steroid withdrawal gave similar 5-year graft survival but more mild rejection.
Steroid withdrawal possible with continued immunosuppression.
Apakah studi ini mendukung klaim spesifik tersebut? Sebagian · Kualitas metodologis: tinggi · Tingkat kepastian bukti: lihat penilaian keseluruhan atas klaim
Publikasi asli · Rincian ilmiah
Penjelasan studi secara sederhana
- Apa yang ingin diketahui para peneliti?
Test early steroid withdrawal
- Bagaimana studi ini dilakukan?
Blinded RCT
- Berapa banyak orang, hewan, atau sampel yang diteliti?
386 recipients
- Apa yang sebenarnya ditemukan?
Similar graft survival; more mild rejection; better metabolic profile
- Seberapa besar efek yang teramati?
rejection 17.8% vs 10.8%
- Apa arti hasilnya dalam kehidupan sehari-hari?
Doctors can sometimes drop cortisone after transplant, but the other anti-rejection drugs stay.
- Apa keterbatasan studi ini?
Selected patients; abstract only
- Apa yang dikatakannya tentang klaim spesifik Elawady?
Partly supports dropping cortisone; contradicts stopping all immunosuppressants.
- Apakah hasilnya berlaku untuk Jerman dan Eropa?
High
- Apa yang secara tegas tidak dapat disimpulkan dari studi ini?
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.pub4Meta-analisispemeriksaan silang independenabstrak diperiksa★ studi kunciAcross 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.
Apakah studi ini mendukung klaim spesifik tersebut? Sebagian · Kualitas metodologis: tinggi · Tingkat kepastian bukti: lihat penilaian keseluruhan atas klaim
Publikasi asli · Rincian ilmiah
Penjelasan studi secara sederhana
- Apa yang ingin diketahui para peneliti?
Find out whether steroids can be left out after a kidney transplant
- Bagaimana studi ini dilakukan?
Cochrane review of randomised trials
- Berapa banyak orang, hewan, atau sampel yang diteliti?
53 trials, 8317 recipients
- Apa yang sebenarnya ditemukan?
Similar short-term graft survival; more acute rejection with steroid avoidance unless combined with modern drugs; less post-transplant diabetes
- Seberapa besar efek yang teramati?
BPAR RR 1.58 (avoidance); graft loss RR 1.19 (withdrawal, CI 0.72-1.96)
- Apa arti hasilnya dalam kehidupan sehari-hari?
Doctors can sometimes stop cortisone, but only while other anti-rejection drugs continue
- Apa keterbatasan studi ini?
Low certainty; mostly unblinded trials
- Apa yang dikatakannya tentang klaim spesifik Elawady?
Supports only steroid withdrawal under specialist care, not stopping all drugs
- Apakah hasilnya berlaku untuk Jerman dan Eropa?
High
- Apa yang secara tegas tidak dapat disimpulkan dari studi ini?
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.xSerial kasus / laporan kasuspemeriksaan silang independenabstrak diperiksa27 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.
Apakah studi ini mendukung klaim spesifik tersebut? Sebagian · Kualitas metodologis: rendah · Tingkat kepastian bukti: lihat penilaian keseluruhan atas klaim
Publikasi asli · Rincian ilmiah
Penjelasan studi secara sederhana
- Apa yang ingin diketahui para peneliti?
Describe patients who tolerate a kidney without drugs
- Bagaimana studi ini dilakukan?
Comparison of a rare cohort with other patients
- Berapa banyak orang, hewan, atau sampel yang diteliti?
27 tolerant patients
- Apa yang sebenarnya ditemukan?
Most kept function for years; 30% slowly deteriorated
- Seberapa besar efek yang teramati?
19/27 stable at mean 9 years
- Apa arti hasilnya dalam kehidupan sehari-hari?
Such cases exist but are rare and cannot be predicted
- Apa keterbatasan studi ini?
Only successes counted
- Apa yang dikatakannya tentang klaim spesifik Elawady?
A rare exception, not a basis for stopping drugs
- Apakah hasilnya berlaku untuk Jerman dan Eropa?
European data
- Apa yang secara tegas tidak dapat disimpulkan dari studi ini?
How many people who stop drugs keep their kidney
Tidak ada studi dalam kelompok ini yang ditandai sebagai studi kunci.
Konteks wilayah
Jerman / UE
Transplant centres in Europe follow KDIGO-type guidance; changes in immunosuppression are made by the transplant team.
Mesir
The same applies in Egypt; graft loss means a return to dialysis.
Apa yang berlaku di negara saya?
Penilaian ilmiah umum
Salah Menghentikan semua obat antipenolakan setelah transplantasi ginjal bukanlah keberhasilan: uji klinis menunjukkan bahwa bahkan menghentikan satu obat utama saja menyebabkan penolakan, dan kenaikan GFR jangka pendek adalah efek obat yang sudah diperkirakan.
Pernyataan ini menyangkut hubungan biologis atau medis. Penilaian ilmiah di atas berlaku tanpa bergantung pada negara; data pangan khusus negara tidak mengubahnya.
Referensi
- 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