Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis
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 pote...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2018-01-01
|
| Series: | Saudi Journal of Kidney Diseases and Transplantation |
| Online Access: | http://www.sjkdt.org/article.asp?issn=1319-2442;year=2018;volume=29;issue=6;spage=1376;epage=1385;aulast=Azarfar |
| _version_ | 1818059885427818496 |
|---|---|
| author | Anoush Azarfar Yalda Ravanshad Hassan Mehrad-Majd Mohammad Esmaeeli Shapour Badiei Aval Maryam Emadzadeh Maryam Salehi Ali Moradi Mohadese Golsorkhi Mahmood Reza Khazaei |
| author_facet | Anoush Azarfar Yalda Ravanshad Hassan Mehrad-Majd Mohammad Esmaeeli Shapour Badiei Aval Maryam Emadzadeh Maryam Salehi Ali Moradi Mohadese Golsorkhi Mahmood Reza Khazaei |
| author_sort | Anoush Azarfar |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T13:23:38Z |
| format | Article |
| id | doaj.art-9d4b048d4c9c4cf3bdda35b01b612167 |
| institution | Directory Open Access Journal |
| issn | 1319-2442 |
| language | English |
| last_indexed | 2024-12-10T13:23:38Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Kidney Diseases and Transplantation |
| spelling | doaj.art-9d4b048d4c9c4cf3bdda35b01b6121672022-12-22T01:47:16ZengWolters Kluwer Medknow PublicationsSaudi Journal of Kidney Diseases and Transplantation1319-24422018-01-012961376138510.4103/1319-2442.248292Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysisAnoush AzarfarYalda RavanshadHassan Mehrad-MajdMohammad EsmaeeliShapour Badiei AvalMaryam EmadzadehMaryam SalehiAli MoradiMohadese GolsorkhiMahmood Reza KhazaeiKidney 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.http://www.sjkdt.org/article.asp?issn=1319-2442;year=2018;volume=29;issue=6;spage=1376;epage=1385;aulast=Azarfar |
| spellingShingle | Anoush Azarfar Yalda Ravanshad Hassan Mehrad-Majd Mohammad Esmaeeli Shapour Badiei Aval Maryam Emadzadeh Maryam Salehi Ali Moradi Mohadese Golsorkhi Mahmood Reza Khazaei Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis Saudi Journal of Kidney Diseases and Transplantation |
| title | Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis |
| title_full | Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis |
| title_fullStr | Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis |
| title_full_unstemmed | Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis |
| title_short | Comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation: An updated systematic review and meta-analysis |
| title_sort | comparison of tacrolimus and cyclosporine for immunosuppression after renal transplantation an updated systematic review and meta analysis |
| url | http://www.sjkdt.org/article.asp?issn=1319-2442;year=2018;volume=29;issue=6;spage=1376;epage=1385;aulast=Azarfar |
| work_keys_str_mv | AT anoushazarfar comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT yaldaravanshad comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT hassanmehradmajd comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT mohammadesmaeeli comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT shapourbadieiaval comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT maryamemadzadeh comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT maryamsalehi comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT alimoradi comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT mohadesegolsorkhi comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis AT mahmoodrezakhazaei comparisonoftacrolimusandcyclosporineforimmunosuppressionafterrenaltransplantationanupdatedsystematicreviewandmetaanalysis |