Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis
| Autor: | Christian A. Gleissner, A. Roussoulieres, Marcelo Cantarovich, Hans B. Lehmkuhl, L. Sebbag, Luciano Potena, Christophe Dufays, Michel Redonnet, Jan Groetzner, Catherine Cornu, Pascale Boissonnat, François Gueyffier, Ségolène Gaillard, Lars Gullestad |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030232 urology & nephrology Urology Renal function 030230 surgery law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial law medicine Pharmacology (medical) Adverse effect Cause of death Pharmacology Heart transplantation Creatinine business.industry 3. Good health Surgery Calcineurin chemistry Meta-analysis business |
| Zdroj: | British Journal of Clinical Pharmacology. 78:24-32 |
| ISSN: | 0306-5251 |
| DOI: | 10.1111/bcp.12289 |
| Popis: | Aims Calcineurin inhibitors (CNIs) taken after heart transplantation lead to excellent short-term outcomes, but long-term use may cause chronic nephrotoxicity. Our aim was to identify, appraise, select and analyse all high-quality research evidence relevant to the question of the clinical impact of CNI-sparing strategies in heart transplant patients. Methods We carried out a systematic review and meta-analysis of randomized controlled trials on CNI reduction in heart transplant recipients. Primary outcomes were kidney function and acute rejection after 1 year. Secondary outcomes included graft loss, all-cause mortality and adverse events. Results Eight open-label studies were included, with 723 patients (four tested de novo CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor reduction did not improve creatinine clearance at 12 months 5.46 [−1.17, 12.03] P = 0.32 I2 = 65.4%. Acute rejection at 12 months (55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates (55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI groups. There was significant benefit on creatinine clearance in patients with impaired renal function at 6 months [+12.23 (+5.26, +18.82) ml min−1, P = 0.0003] and at 12 months 4.63 [−4.55, 13.82] P = 0.32 I2 = 75%. Conclusions This meta-analysis did not demonstrate a favourable effect of CNI reduction on kidney function, but there was no increase in acute rejection. To provide a better analysis of the influence of CNI reduction patterns and associated treatments, a meta-analysis of individual patient data should be performed. |
| Databáze: | OpenAIRE |
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