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Tacrolimus versus cyclosporin for immunosuppression in renal transplantation: meta-analysis of randomised trials
Copyright policy )Tacrolimus versus cyclosporin for immunosuppression in renal transplantation: meta-analysis of randomised trials
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.
- University of Ottawa Canada
Microsoft Academic Graph classification: medicine.medical_specialty medicine.medical_treatment Internal medicine medicine Kidney transplantation business.industry Immunosuppression Odds ratio Ciclosporin medicine.disease Tacrolimus Surgery Transplantation Chemoprophylaxis business medicine.drug Kidney disease
Medical Subject Headings: chemical and pharmacologic phenomena surgical procedures, operative
Adult, Graft Rejection, Male, Tacrolimus, Meta-Analysis as Topic, Humans, Randomized Controlled Trials as Topic, General Environmental Science, Immunosuppression Therapy, General Engineering, General Medicine, Middle Aged, Kidney Transplantation, Papers, Cyclosporine, General Earth and Planetary Sciences, Female, Immunosuppressive Agents
Adult, Graft Rejection, Male, Tacrolimus, Meta-Analysis as Topic, Humans, Randomized Controlled Trials as Topic, General Environmental Science, Immunosuppression Therapy, General Engineering, General Medicine, Middle Aged, Kidney Transplantation, Papers, Cyclosporine, General Earth and Planetary Sciences, Female, Immunosuppressive Agents
Microsoft Academic Graph classification: medicine.medical_specialty medicine.medical_treatment Internal medicine medicine Kidney transplantation business.industry Immunosuppression Odds ratio Ciclosporin medicine.disease Tacrolimus Surgery Transplantation Chemoprophylaxis business medicine.drug Kidney disease
Medical Subject Headings: chemical and pharmacologic phenomena surgical procedures, operative
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).249 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 1% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 1% citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).249 popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.Top 10% influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).Top 1% impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.Top 1%
Citations provided by BIP!Popularity provided by BIP!- 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.