mTOR inhibitor versus mycophenolic acid as the primary immunosuppression regime combined with calcineurin inhibitor for kidney transplant recipients: a meta-analysis
| Autor: | Xiuxiu Lai, Zhangfei Shou, Jianghua Chen, Xishao Xie, Shilong Xiang, Yan Jiang |
|---|---|
| Jazyk: | angličtina |
| Předmět: |
Graft Rejection
medicine.medical_specialty mTOR inhibitor Calcineurin Inhibitors Peripheral edema Lower risk Gastroenterology Tacrolimus Mycophenolic acid Adrenal Cortex Hormones Internal medicine medicine Humans Everolimus Kidney transplantation Sirolimus business.industry TOR Serine-Threonine Kinases Mycophenolic Acid medicine.disease Kidney Transplantation Calcineurin Meta-analysis Treatment Outcome Nephrology Relative risk Cyclosporine Drug Therapy Combination medicine.symptom business Immunosuppressive Agents Research Article medicine.drug |
| Zdroj: | BMC Nephrology |
| ISSN: | 1471-2369 |
| DOI: | 10.1186/s12882-015-0078-5 |
| Popis: | Background A number of studies have provided information regarding the risks and benefits of mammalian target of rapamycin inhibitors (mTOR-I) combined with calcineurin inhibitors (CNI) versus mycophenolic acid (MPA). Methods Medline, Embase and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials comparing mTOR-I to MPA as the primary immunosuppressive regimen in combination with CNI were selected and meta-analyzed. Results Eleven randomized controlled trials consisting of 4930 patients in total were included. No significant difference was observed in the risk of biopsy-proven acute rejection and patient death between the two groups. However, an increased risk of graft loss (relative risk (RR) = 1.20) and inferior graft function (creatinine clearance, weighted mean difference (WMD) = −2.41 μmol/L) were demonstrated in mTOR-I-treated patients. Patients treated with mTOR-I had a higher risk of new-onset diabetes mellitus (RR = 1.32), dyslipidemia, proteinuria (RR = 1.79), peripheral edema (RR = 1.34), thrombocytopenia (RR = 1.97) and lymphocoele (RR = 1.80), but a lower risk of cytomegalovirus infection (RR = 0.40), malignancy (RR = 0.64) and leucopenia (RR = 0.43). There was no difference in diarrhea, anemia, urinary tract infection, polyoma virus infection and impaired wound healing when mTOR-I was compared with MPA. Conclusions mTOR-I showed no particular superiority to MPA. Notably, mTOR-I had an increased risk of graft loss when combined with CNI, even when combined with a reduced dose of CNI. Therefore, the optimal dosage strategies for mTOR-I and CNI need to be further explored. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0078-5) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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