Calcineurin Inhibitor Avoidance and Withdrawal for Kidney Transplantation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Yan, Hong; Zong, Huantao; Cui, Yuanshan; Li, N.; Zhang, Y.

doi:10.1016/j.transproceed.2014.02.010

Cited by 15 publications

(12 citation statements)

References 30 publications

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“…Eur J Gen Med 2016;13(3): [16][17][18][19][20][21][22] mmHg; P=0.04) in the SRL and Tac groups, respectively. At 36 month, the mean systolic blood pressure (132±19 and 141±21 mmHg; P=0.001) and diastolic blood pressure (74±14 mmHg and 82±10 mmHg; P=0.001) in the SRL and Tac groups, respectively.…”

Section: Blood Pressurementioning

confidence: 97%

“…Oral prednisolone was then given at a dose of 1 mg/ kg per day, and then gradually tapered down to 5 mg/day by the 3rd month post-transplantation. Tacrolimus was started at a dose of 0.075 mg/kg/day in two divided doses targeting Eur J Gen Med 2016;13(3): [16][17][18][19][20][21][22] a 12-h whole blood trough level of 10-15 ng/mL in the first 3 months and then from 3 to 7 ng/ml thereafter. Concomitant immunosuppression and other treatments (i.e.…”

Section: Immunosuppression Protocolmentioning

confidence: 99%

“…It may also have a role as an effective substitute for CNI therapy late after transplantation to avoid further CNI nephrotoxicity (18)(19)(20)(21)(22)(23). However, the potential risk and benefit of this conversion strategy is not yet fully known, especially in the long term.…”

Section: Introductionmentioning

confidence: 99%

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Sirolimus-based, calcineurin inhibitor- free regimen in kidney transplant patients: An open-label, randomized, controlled trial

et al. 2016

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Background/Aim: We report a prospective, open-label, randomized study to evaluate the safety and efficacy of converting patients with stable renal function from Tacrolimus (Tac)-based regimen to a Sirolimus (SRL)-based regimen after kidney transplantation. Methods: Fifty eight low risk renal allograft recipients who were eligible to the study, 6 months posttransplant and receiving Tac, were randomly assigned to continue Tac (n=29) or convert to SRL (n=29). We evaluated the 3-year outcomes including patient and graft survival, graft function and safety profile. Results: 3-year patient and graft survival in SRL and Tac groups was 93.1% vs. 100% (P=0.04), and 89.7% vs. 100% (P=0.04), respectively. However, the SRL group had significantly better renal function, from the second year post-transplant until the last follow-up. Four (13.8%) patients in the SRL group and 3 (10.3%) in the Tac group (P=0.5) developed biopsy proven acute rejection. Mean urinary protein excretion increased significantly after SRL conversion. Diastolic blood pressure was significantly lower in patients who eliminated tacrolimus (80.4 vs. 75.6 mmHg) (P = 0.03). Mean hemoglobin concentrations decreased after SRL conversion and remained significantly lower from 12 months to 36 months (P=0.01). The mean serum cholesterol and triglyceride levels increased significantly in the SRL group, (P < 0.05). Conclusions: our experience demonstrates that conversion to sirolimus from calcineurin inhibitors (CNI)-based therapy may result in better renal function and blood pressure control in renal transplant recipients without an increased risk of acute rejection. However, these benefits have not resulted in a growing advantage in graft or patient survival.

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Section: Blood Pressurementioning

confidence: 97%

Section: Immunosuppression Protocolmentioning

confidence: 99%

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Sirolimus-based, calcineurin inhibitor- free regimen in kidney transplant patients: An open-label, randomized, controlled trial

et al. 2016

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“…[161718] It may also have a role as an effective substitute for CNI therapy late after transplantation to avoid further CNI nephrotoxicity. [192021222324] However, the potential risk and benefit of this conversion strategy are not yet fully known, especially in the long-term.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of early tacrolimus conversion to sirolimus after kidney transplantation: Long-term results of a prospective randomized study

et al. 2017

Indian J Nephrol

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We report a prospective, open-label, randomized study to evaluate the safety and efficacy of converting patients with a stable renal function from tacrolimus (Tac)-based regimen to a sirolimus (SRL)-based regimen after kidney transplantation. Fifty-eight low-risk renal allograft recipients who receiving Tac 6 months posttransplant, were randomly assigned to continue Tac (n = 29) or convert to SRL (n = 29). We evaluated the 3-year outcomes including patient and graft survival, graft function, and safety profile. Three-year patient and graft survival in SRL and Tac groups were 93.1% versus 100% (P = 0.32), and 89.7% versus 100% (P = 0.11), respectively. However, the SRL group had a significantly better renal function, from the 2nd year posttransplant until the last follow-up. Four (13.8%) patients in the SRL group and 3 (10.3%) in the Tac group (P = 0.5) developed biopsy-proven acute rejection. Mean urinary protein excretion increased significantly after SRL conversion. Diastolic blood pressure was significantly lower at the end of the study in patients who eliminated Tac (80.4 vs. 75.6 mmHg in Tac and SRL group, respectively) (P = 0.03). Mean hemoglobin concentrations decreased after SRL conversion and remained significantly lower from 12 months to 36 months (P = 0.01). The mean serum cholesterol (540 ± 44 mg/dl) and triglyceride (177 ± 27 mg/dl) increased significantly in the SRL group, compared to Tac group (487 ± 62 mg/dl) (P = 0.03) and (141 ± 26 mg/dl) (P = 0.04). Our experience demonstrates that conversion to SRL from calcineurin inhibitors-based therapy may result in better renal function and blood pressure control in renal transplant recipients without an increased risk of acute rejection. However, these benefits have not resulted in a growing advantage in graft or patient survival.

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“…Several other studies investigated CNI‐sparing strategies and systematic reviews and meta‐analyses recently unraveled this issue . One meta‐analysis specifically focused on strategies involving MMF .…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcome after early cyclosporine withdrawal in kidney transplantation: ten years after

Tabibzadeh

Glowacki

Frimat

et al. 2016

Clinical Transplantation

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Calcineurin Inhibitor Avoidance and Withdrawal for Kidney Transplantation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Cited by 15 publications

References 30 publications

Sirolimus-based, calcineurin inhibitor- free regimen in kidney transplant patients: An open-label, randomized, controlled trial

Sirolimus-based, calcineurin inhibitor- free regimen in kidney transplant patients: An open-label, randomized, controlled trial

Efficacy and safety of early tacrolimus conversion to sirolimus after kidney transplantation: Long-term results of a prospective randomized study

Long‐term outcome after early cyclosporine withdrawal in kidney transplantation: ten years after

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