A Meta Analysis of Low-Dose Tacrolimus Immunosuppressive Therapy in Kidney Transplant Recipients_West China Medical Journal

Authors：

WU Bin ¹ , LU Jing ¹ , CHEN Yunxi ² ,  TANG Yao ¹

1.Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China. 2. Department of Pharmacy, The Electric Worker’s Hospital of Guizhou, Guiyang, Guizhou 550002, P.R.China;

Corresponding?author：

TANG Yao, Email: binw83@yahoo.cn

Keywords：

他克莫司; 劑量; 腎移植; Meta分析

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

【摘要】目的 評價腎移植術后他克莫司（TAC）低劑量對比常規劑量干預的療效和安全性。方法檢索MEDLINE、EMbase、SCI、CBM、Cochrane圖書館，納入腎移植術后TAC低劑量對比常規劑量免疫抑制治療的隨機對照試驗（RCT）。檢索時間從各個數據庫建庫至2009年12月，對納入研究進行方法學質量評價和Meta分析。結果納入3個RCT，其中A級研究2個，B級研究1個。分析結果顯示:兩組急性排斥反應發生率比較，無統計學意義[RR=1.39， 95%CI(0.64， 3.01)]；腎小球濾過率、受者/移植物生存率和納入分析的安全性指標差異均無統計學意義。結論基于當前臨床證據，腎移植術后TAC低劑量與常規劑量干預相比，近期療效和安全性相似；遠期結果尚需進一步研究探討。
【Abstract】 Objective To evaluate the effect and safety of low-dose versus standard-dose tacrolimus immunosuppressive therapy on kidney transplant recipients. Methods MEDLINE, EMbase, SCI, CBM and the Cochrane library were searched and randomized controlled trials (RCT) of low-dose versus standard-dose tacrolimus immunosuppressive therapy in kidney transplant recipients were gathered. The search was updated in December 2009. Quality assessment and meta-analysis were performed. Results A total of three RCT were identified, two of which were graded A and one was graded B. The analysis results indicated that RR (95%CI) value of the acute rejection rate was 1.39 (0.64, 3.01); glomerular filtration rate, patient/graft survival rate, and safety analysis were not significant different between the two groups. Conclusion Based on the evidence currently, compared to standard-dose TAC, Low-dose TAC has the same effect and safety results, but further study are needed to get the long term results.

Citation： WU Bin,LU Jing,CHEN Yunxi,TANG Yao. A Meta Analysis of Low-Dose Tacrolimus Immunosuppressive Therapy in Kidney Transplant Recipients. West China Medical Journal, 2010, 25(10): 1857-1859. doi: Copy

1.	Sutherland DE, Gores PF, Farney AC, et al. Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota[J]. Am J Surg, 1993, 166(5): 456-491.
2.	Webster AC, Woodroffe RC, Taylor RS, et al. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data[J]. BMJ, 2005, 331(7520): 810.
3.	Gaston RS. Chronic calcineurin inhibitor nephrotoxicity: reflections on an evolving paradigm[J]. Clin J Am Soc Nephrol, 2009, 4(12): 2029-2034.
4.	Haller M, Oberbauer R. Calcineurin inhibitor minimization, withdrawal and avoidance protocols after kidney transplantation[J]. Transpl Int, 2009, 22(1): 69-77.
5.	吳斌, 柳汝明, 唐堯. 腎移植術后低劑量與常規劑量環孢素A比較進行免疫抑制治療有效性與安全性的Meta分析[J]. 中國循證醫學雜志, 2010, 10(6): 683-687.
6.	Juni P, Altman DG, Eger M. Assessing the quality of controlled clinical trails[J]. BMJ, 2001, 323: 42-46.
7.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 0. 1 [DB]. The Cochrane Collaboration, 2008. Available at: www. cochranehandbook. org.
8.	Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med, 2002, 21(11): 1539-1558.
9.	Chan L, Greenstein S, Hardy MA, et al. Multicenter, randomized study of the use of everolimus with tacrolimus after renal transplantation demonstrates its effectiveness[J]. Transplantation, 2008, 85(6): 821-826.
10.	Light JA, Sasaki TM, Ghasemian R, et al. Daclizumab induction/tacrolimus sparing: a randomized prospective trial in renal transplantation[J]. Clinical Transplantation, 2002, 16(Suppl 7): 30-33.
11.	Laskow DA, Vincenti F, Neylan JF, et al. An open-label, concentration-ranging trial of FK506 in primary kidney transplantation: a report of the United States Multicenter FK506 Kidney Transplant Group[J]. Transplantation, 1996, 62(7): 900-905.

1. Sutherland DE, Gores PF, Farney AC, et al. Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota[J]. Am J Surg, 1993, 166(5): 456-491.
2. Webster AC, Woodroffe RC, Taylor RS, et al. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data[J]. BMJ, 2005, 331(7520): 810.
3. Gaston RS. Chronic calcineurin inhibitor nephrotoxicity: reflections on an evolving paradigm[J]. Clin J Am Soc Nephrol, 2009, 4(12): 2029-2034.
4. Haller M, Oberbauer R. Calcineurin inhibitor minimization, withdrawal and avoidance protocols after kidney transplantation[J]. Transpl Int, 2009, 22(1): 69-77.
5. 吳斌, 柳汝明, 唐堯. 腎移植術后低劑量與常規劑量環孢素A比較進行免疫抑制治療有效性與安全性的Meta分析[J]. 中國循證醫學雜志, 2010, 10(6): 683-687.
6. Juni P, Altman DG, Eger M. Assessing the quality of controlled clinical trails[J]. BMJ, 2001, 323: 42-46.
7. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5. 0. 1 [DB]. The Cochrane Collaboration, 2008. Available at: www. cochranehandbook. org.
8. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Stat Med, 2002, 21(11): 1539-1558.
9. Chan L, Greenstein S, Hardy MA, et al. Multicenter, randomized study of the use of everolimus with tacrolimus after renal transplantation demonstrates its effectiveness[J]. Transplantation, 2008, 85(6): 821-826.
10. Light JA, Sasaki TM, Ghasemian R, et al. Daclizumab induction/tacrolimus sparing: a randomized prospective trial in renal transplantation[J]. Clinical Transplantation, 2002, 16(Suppl 7): 30-33.
11. Laskow DA, Vincenti F, Neylan JF, et al. An open-label, concentration-ranging trial of FK506 in primary kidney transplantation: a report of the United States Multicenter FK506 Kidney Transplant Group[J]. Transplantation, 1996, 62(7): 900-905.

West China Medical Journal

A Meta Analysis of Low-Dose Tacrolimus Immunosuppressive Therapy in Kidney Transplant Recipients

Abstract Full text Figures/Tables Video References Cited by

Format

Content