Outcomes of late corticosteroid withdrawal after renal transplantation in patients exposed to tacrolimus and/or mycophenolate mofetil: meta-analysis of randomized controlled trials

Corticosteroids are increasingly used in renal transplant patients to minimize organ rejection after transplantation. In attempts to reduce corticosteroids adverse effects, transplant professionals are customary attempted to taper off, and permanently stop corticosteroids after few months of administration with other immunosuppressants. To evaluate clinical benefits and risks of late corticosteroid withdrawal in renal transplant patients treated with tacrolimus [TAC] or mycophenolate mofetil [MMF], or both. A meta-analysis was performed of published randomized controlled trials that reported outcomes in kidney transplant patients who were randomized to corticosteroids maintenance or late withdrawal under concomitant immunosuppression by TAC, MMF or both. Outcomes included acute graft rejection; graft failure rate; all-cause mortality; incidence of post-transplant diabetes; change in serum creatinine and total cholesterol; and change in pediatric standardized height z-score. PubMed and Google Scholar were used in literature search between 1999 and April 1, 2010. Data were combined using unweighted random effects model. Nine studies randomized 1907 patients met the inclusion criteria: TAC [n=1]; MMF [n=6]; both [n=2]. Compared to maintenance therapy, late corticosteroid withdrawal was associated with 34% increase in the risk of acute graft rejection [95% CI for OR: 0.47-3.82]; 35% and 5% reductions in the risk of graft failure and patient's all-cause mortality [95% CI for OR: 0.26-1.60; 0.23-3.93, respectively]; and 4% increase in post-transplant diabetes risk [95% CI for OR: 0.45-2.41]. Late corticosteroid withdrawal was associated with substantial reduction in total cholesterol levels [mean difference: 18.1 mg/dL; 95% CI: 7.1-29.0 mg/dL], but did not reduce serum creatinine levels [-0.00 mg/dL; 95% CI: -0.17 to 0.17]. Stopping corticosteroids was associated with better pediatric growth outcomes. Late corticosteroid withdrawal under TAC and/or MMF-lead immunosuppression after kidney transplantation could provide benefits in terms of total cholesterol, patient and graft survival, and pediatric growth. This strategy, however did not reduce the risk of acute graft rejection, post-transplant diabetes mellitus, and deterioration in serum creatinine levels

Response surface and fixed effects models of non - genetic factors for dairy cows in Saudi Arabia

Response surface model of statistical analysis was used to quantify the relationship between non-genetic factors [NGF] such as days open [DO], days in milk [DIM], age at calving and milk production. Data included 103.776 records; each one had cow identification, non genetic traits and production traits such as total milk production. 305-milk yield and peak yield. Least square means of three farms were 10467, 11047 and 10697 liters of milk respectively. Cows calved on fall-winter season produced 10839 liters, compared with 10636 liters for cows calved in spring-summer season. Second lactation cows gave the highest production [11, 105 liters], and sixth lactation cows produced the lowest production [10, 283 liters]. Significant parameters [p < .01] supported the linear and quadratic relationship between age at calving and total yield, 305-dyield and peak milk production, respectively. The DIM had a significant linear effect on milk production [p < .01]. Also, quadratic representation of DIM was observed along the whole milk curve. Days open showed no linear significant effect on milk production. However, significant quadratic effect [p < .05] was found between DO and 305-d yield, The ANOVA of fixed model showed a significant effect of NGF on production traits