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Tacrolimus versus cyclosporin for immunosuppression in renal transplantation: meta-analysis of randomised trials.
Copyright policy )Abstract Objective : To compare tacrolimus with cyclosporin for immunosuppression in renal transplantation. Design : Meta-analysis of randomised trials of two treatments after kidney transplantation. Identification : Four studies involving 1037 patients. Trials were included if they were randomised, the intervention group received tacrolimus, the control group received cyclosporin, the patients were followed for a minimum of 12 months, and patient survival, graft survival, incidence of acute rejection, need for antilymphocyte treatment, or the prevalence of diabetes mellitus after transplant was reported. Main outcome measures : Pooled estimates of patient mortality, allograft loss, and episodes of acute rejection 1 year after transplantation. Results : The odds ratio for loss of allograft with tacrolimus compared with cyclosporin was 0.95 (95% confidence interval 0.65 to 1.40). The odds ratio for mortality with tacrolimus was 1.07 (0.47 to 2.48). Treatment with tacrolimus was associated with a reduction in episodes of acute rejection (0.52; 0.36 to 0.75), a reduction in the use of antilymphocyte antibodies to treat rejection (0.37; 0.25 to 0.56), and an increased prevalence of diabetes mellitus after transplantation (5.03; 2.04 to 12.36) compared with treatment with cyclosporin. Conclusions : After renal transplantation, immunosuppression with tacrolimus results in a significant reduction in acute rejection compared with cyclosporin. Follow up studies of high methodological quality are needed to determine whether tacrolimus improves long term renal graft survival.
Microsoft Academic Graph classification: Kidney disease medicine.disease medicine Odds ratio Kidney transplantation Chemoprophylaxis Surgery medicine.medical_specialty Transplantation Immunosuppression medicine.medical_treatment business.industry business Ciclosporin medicine.drug Tacrolimus Internal medicine
Medical Subject Headings: surgical procedures, operative chemical and pharmacologic phenomena
Adult, Cyclosporine, Female, Graft Rejection, Humans, Immunosuppression Therapy, Immunosuppressive Agents, Kidney Transplantation, Male, Middle Aged, Randomized Controlled Trials as Topic, Tacrolimus, General Medicine, General Earth and Planetary Sciences, General Engineering, General Environmental Science, Papers, Meta-Analysis as Topic
Adult, Cyclosporine, Female, Graft Rejection, Humans, Immunosuppression Therapy, Immunosuppressive Agents, Kidney Transplantation, Male, Middle Aged, Randomized Controlled Trials as Topic, Tacrolimus, General Medicine, General Earth and Planetary Sciences, General Engineering, General Environmental Science, Papers, Meta-Analysis as Topic
Microsoft Academic Graph classification: Kidney disease medicine.disease medicine Odds ratio Kidney transplantation Chemoprophylaxis Surgery medicine.medical_specialty Transplantation Immunosuppression medicine.medical_treatment business.industry business Ciclosporin medicine.drug Tacrolimus Internal medicine
Medical Subject Headings: surgical procedures, operative chemical and pharmacologic phenomena
- University of Ottawa Canada
- University of Ottawa Canada
Abstract Objective : To compare tacrolimus with cyclosporin for immunosuppression in renal transplantation. Design : Meta-analysis of randomised trials of two treatments after kidney transplantation. Identification : Four studies involving 1037 patients. Trials were included if they were randomised, the intervention group received tacrolimus, the control group received cyclosporin, the patients were followed for a minimum of 12 months, and patient survival, graft survival, incidence of acute rejection, need for antilymphocyte treatment, or the prevalence of diabetes mellitus after transplant was reported. Main outcome measures : Pooled estimates of patient mortality, allograft loss, and episodes of acute rejection 1 year after transplantation. Results : The odds ratio for loss of allograft with tacrolimus compared with cyclosporin was 0.95 (95% confidence interval 0.65 to 1.40). The odds ratio for mortality with tacrolimus was 1.07 (0.47 to 2.48). Treatment with tacrolimus was associated with a reduction in episodes of acute rejection (0.52; 0.36 to 0.75), a reduction in the use of antilymphocyte antibodies to treat rejection (0.37; 0.25 to 0.56), and an increased prevalence of diabetes mellitus after transplantation (5.03; 2.04 to 12.36) compared with treatment with cyclosporin. Conclusions : After renal transplantation, immunosuppression with tacrolimus results in a significant reduction in acute rejection compared with cyclosporin. Follow up studies of high methodological quality are needed to determine whether tacrolimus improves long term renal graft survival.