Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis

Azarfar, A. and Ravanshad, Y. and Mehrad-Majd, H. and Esmaeeli, M. and Aval, S. B. and Emadzadeh, M. and Salehi, M. and Moradi, A. and Golsorkhi, M. and Khazaei, M. R. (2018) Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 29 (6). pp. 1376-1385.

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Abstract

Kidney transplantation is usually followed by immunosuppressive therapy to prevent early rejection and prolong graft survival. The calcineurin inhibitors (CNIs) represent the most commonly used agents. However, available evidence suggests the poor outcome over the long term, maybe be due to the potential nephrotoxicity associated with CNIs. Several randomized trials have compared tacrolimus (TAC) with cyclosporine, to find the optimal agent for renal transplantation; however, studies have shown conflicting results. The aim of this study was to systematically review and update the evidence for the benefits and harm of TAC versus cyclosporine as the primary immunosuppression after renal transplantation. The study was a systematic review and meta-analysis. An electronic literature search was conducted to identify appropriated trial studies. The outcomes were presented as relative risk (RR), with 95 confidence intervals (CI). Statistical analysis used was meta-analysis. Twenty-one eligible randomized controlled trials were included in this systematic review. TAC was significantly superior to cyclosporine considering the total effect size of graft loss (RR 0.089; 95 CI0.057-0.122, P <0.001), acute rejection (RR 0.638; 95 CI 0.571-0.713, P <0.001) and hypercholeste-rolemia (RR 0.634; 95 CI, 0.539-0.746, P <0.001). On the contrary, cyclosporine seemed to be significantly superior to TAC with regard to diabetes (RR 1.891; 95 CI 1.522-2.350, P <0.001). However, no significant differences between the two CNIs were found with regard to mortality, infection, and hypertension. The review indicates that TAC is significantly superior to cyclosporine regarding graft loss, acute rejection, and hypercholesterolemia, but cyclosporine seems to be significantly superior to TAC regarding diabetes. However, further large randomized trials are suggested.

Item Type: Article
Additional Information: Cited By :3 Export Date: 16 February 2020
Uncontrolled Keywords: calcineurin inhibitor cyclosporine immunosuppressive agent tacrolimus adult adverse event drug effect female graft rejection graft survival human immunology kidney transplantation male meta analysis middle aged mortality risk factor time factor treatment outcome Calcineurin Inhibitors Humans Immunosuppressive Agents Risk Factors Time Factors
Subjects: WJ Urogenital System
QW Microbiology and Immunology
Divisions: Mashhad University of Medical Sciences
Depositing User: lib2 lib2 lib2
Date Deposited: 08 Jun 2020 05:15
Last Modified: 08 Jun 2020 05:15
URI: http://eprints.mums.ac.ir/id/eprint/17218

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