Systematic review and meta-analysis of calcineurin inhibitors on long-term prognosis of renal transplant patients

Abstract

Background: Existing guidelines recommend a triple immunosuppressive regimen with calcineurin inhibitors, antimetabolites, and corticosteroids for postoperative immunosuppression in renal transplant patients. However, few studies have compared cyclosporine and tacrolimus for long-term outcomes. In this study, the meta-analysis was used to compare long-term outcomes in renal transplant patients to evaluate the use of cyclosporine vs. tacrolimus. The pros and cons of suppression programs have been analyzed.

Methods: Cyclosporine, tacrolimus, and kidney transplantation, were used as search terms to retrieve relevant publications in PubMed, Embase, and The Cochrane library. Two independent researchers screened and evaluated the relevant results of each search using the RevMan5.4 program to make relevant charts for the meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were used to report dichotomous variables, while mean differences (MD) and 95% confidence intervals (CI) were used to report continuous variables. The study took tacrolimus- and cyclosporine-based maintenance immunosuppression as experimental and control groups, respectively. The graft and patient survival outcomes were followed for 5 or more years.

Results: Overall, thirteen studies were included in the meta-analysis, including nine randomized controlled trials and four non-randomized controlled trials. Compared with the cyclosporine group, the incidence of rejection, drug conversion, and dyslipidemia were significantly lower in the tacrolimus group. Furthermore, there was higher glomerular filtration rates and graft survival rates in the tacrolimus group than in the cyclosporine group. In contrast, there were no significant differences between the two groups in terms of patient survival, incidence of infection, hypertension and new tumors. However, the use of tacrolimus was associated with a high risk of a new onset of diabetes.

Conclusion: The meta-analysis showed that, compared with cyclosporine, tacrolimus increases the risk of a new-onset diabetes. However, tacrolimus had higher graft survival rate and better creatinine clearance than cyclosporine.

Keywords: Cyclosporine; Kidney transplantation; Meta-analysis; Prognosis; Tacrolimus.