Forest plot comparing the estimated glomerular filtration rate between the SAW and SB groups of paediatric renal allograft recipients at different time points post-withdrawal.

<p>A. 6 months; B. 1 year; and C. 2 years. Abbreviations: eGFR, estimated glomerular filtration rate; SAW, steroid avoidance or withdrawal; SB, steroid-based; SD, standard deviation; IV, inverse variance; CI, confidence interval. * Data from the TWIST study (Webb 2015) were excluded because the eGFR distribution was likely skewed at 1 or 2 years after withdrawal; thus, it was inappropriate to convert the interquartile range into a standard deviation. Produced by RevMan Version 5.2.</p

Forest plot comparing the risk of AR between the SAW and SB groups of paediatric renal allograft recipients.

<p>A. No stratification; B. comparison at 1 year and over 1 year post-withdrawal; C. stratified by the time of initiation of steroid withdrawal. Abbreviations: AR, acute rejection; SAW, steroid avoidance or withdrawal; SB, steroid-based; M-H, Mantel-Haenszel; CI, confidence interval. Produced by RevMan Version 5.2.</p

Forest plot comparing the risk of adverse events between the SAW and SB groups of paediatric renal allograft recipients.

<p>A. Hypertension, NODAT, infection and CMV infection (fixed effects model, Mantel-Haenszel method); B. delayed graft function and anaemia (random effects model, Mantel-Haenszel method). *Comparison of the risk of at least one type of infection. Abbreviations: NODAT, new-onset diabetes after transplant; CMV, cytomegalovirus; SAW, steroid avoidance or withdrawal; SB, steroid-based; M-H, Mantel-Haenszel; CI, confidence interval. Produced by RevMan Version 5.2.</p

Summary of findings.

<p>Summary of findings.</p

Flow chart showing the sources and identification of the included studies.

<p>Abbreviations: RCT, randomised controlled trial; SAW, steroid avoidance or withdrawal.</p

Characteristics of the included studies.

<p>Characteristics of the included studies.</p

Forest plot comparing the change in height z-score between the SAW and SB groups of paediatric renal allograft recipients.

<p>A. No stratification; B. comparison at 1 year and over 1 year post-withdrawal; C. stratified by developmental status; D. stratified by the time of initiation of steroid withdrawal. Abbreviations: ΔHSDS, height z-score change; SAW, steroid avoidance or withdrawal; SB, steroid-based; SD, standard deviation; IV, inverse variance; CI, confidence interval. Produced by RevMan Version 5.2.</p

Summary of survival data.

<p>Summary of survival data.</p

Value of original and modified pathological scoring systems for prognostic prediction in paraffin-embedded donor kidney core biopsy

No study has validated, compared and adapted scoring systems for prognosis prediction based on donor kidney core biopsy (CB), with less glomeruli than wedge biopsy. A total of 185 donor kidney CB specimens were reviewed using seven scoring systems. The association between the total score, item scores, score-based grading, and allograft prognosis was investigated. In specimens with less than ten glomeruli (88/185, 47.6%), scoring systems were modified by adjusting weights of the item scores. The Maryland aggregate pathology index (MAPI) score-based grading and periglomerular fibrosis (PGF) associated with delayed graft function (DGF) (Grade: OR = 1.59, p p = 0.006). Total score, score-based grading and chronic lesion score in scoring systems associated with one-year and 3-year eGFR after transplantation. Total-score-based models had similar predictive capacities for eGFR in all scoring systems, except MAPI and Ugarte. Score of glomerulosclerosis (GS), interstitial fibrosis (IF), tubular atrophy (TA), and arteriolar hyalinosis (AH) had good eGFR predictive capacities. In specimens with less than ten glomeruli, modified scoring systems had better eGFR predictive capacities than original scoring systems. Scoring systems could predict allograft prognosis in paraffin-embedded CB with ten more glomeruli. A simple and pragmatic scoring system should include GS, IF, TA and AH, with weights assigned based on predictive capacity for prognosis. Replacing GS scores with tubulointerstitial scores could significantly improve the predictive capacity of eGFR. The conclusion should be further validated in frozen section.</p