Efficacy of corticosteroid pretreatment in the management of deceased organ donors: A systematic review and meta-analysis.

BACKGROUND

Corticosteroid pretreatment of deceased donors may improve transplant outcomes by counteracting hypothalamic-pituitary-adrenal axis dysfunction and systemic inflammation, but the evidence from randomized controlled trials (RCTs) remains inconclusive. This systematic review aims to elucidate any potential transplant outcome benefits through a meta-analysis.

METHODS

A systematic review and meta-analyses were conducted following PRISMA 2020 guidelines. RCTs examining corticosteroid administration to deceased donors were identified through database searches in Ovid MEDLINE, Ovid Embase, CENTRAL, and Web of Science (Core Collection), up to March 2024. Random-effects meta-analysis and subgroup analyses were performed, with evidence quality assessed using GRADE.

RESULTS

Eleven studies examining 10 RCTs (n = 687 donors; 1680 recipients) were included. Corticosteroid pretreatment showed no significant benefit for incidence of donor vasopressor use (RR 0.95, 95% CI 0.87 to 1.05), delayed recipient graft function (RR 0.91, 95% CI 0.53-1.57), recipient graft dysfunction (RR 0.95, 95% CI 0.83-1.10), recipient length of stay (MD 0.46 days, 95% CI -6.99-7.91), recipient acute graft rejection (RR 0.93, 95% CI 0.53-1.61), recipient graft survival (RR 1.03, 95% CI 0.98-1.10), and recipient mortality (RR 0.72, 95% CI 0.37-1.38). Subgroup and meta-regression analyses revealed no consistent benefits, though heterogeneity in corticosteroid regimens and donor-recipient characteristics limited interpretation. The risk of bias was high across most studies.

CONCLUSIONS

Corticosteroid pretreatment demonstrates no clear benefit for deceased donor transplant outcomes. Methodological limitations and heterogeneity underscore the need for robust RCTs.