Tacrolimus versus Cyclosporine A for Simultaneous Pancreas-Kidney Transplant Recipients: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WU Bin , LU Jing , LI Jian , LIU Ruming ,  TANG Yao

Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

TANG Yao, Email: yaotangwch@yahoo.cn

Keywords：

Simultaneous pancreas-kidney transplantation; Immunosuppression; Tacrolimus; Cyclosporine; Meta-analysis

DOI：

10.7507/1672-2531.20090218

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To find out the beneficial and harmful effectiveness of tacrolimus (TAC) compared with cyclosporine A (CSA) for simultaneous pancreas-kidney transplant (SPKT) recipients.
Methods 　Randomized controlled trials (RCTs) of TAC versus CSA for SPKT recipients were collected from The Cochrane Library, MEDLINE, EMbase, SCI, and CBM database. Bias risk assessment and meta-analysis were performed based on the methods recommended by the Cochrane Collaboration.
Results 　Five RCTs including 342 recipients were included. Pooled data of pancreas survival favored TAC (RR=1.15, 95%CI 1.04 to 1.27; RD=0.11, 95%CI 0.03 to 0.19). However, there were no significant differences of acute rejection (RR=0.81, 95%CI 0.58 to 1.12), patient survival (RR=1.00, 95%CI 0.94 to 1.05), kidney survival (RR=1.02, 95%CI 0.95 to 1.09), and infection (RR=1.00, 95%CI 0.83 to 1.20).
Conclusion 　Based on the recent evidence, TAC results in higher episodes of pancreas survival compared with CSA after SPKT. Treating 100 patients with TAC instead of CSA would increase pancreas survival in 11 recipients.

Citation： WU Bin,LU Jing,LI Jian,LIU Ruming,TANG Yao. Tacrolimus versus Cyclosporine A for Simultaneous Pancreas-Kidney Transplant Recipients: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2009, 09(11): 1214-1219. doi: 10.7507/1672-2531.20090218 Copy

1.	Kelly WD, Lillehei RC, Merkel FK, et al. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery, 1967, 61(6): 827-837.
2.	Knoll GA, Nichol G. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options. J Am Soc Nephrol, 2003, 14(2): 500-515.
3.	Arbogast H, Malaise J, Illner WD, et al. Rejection after simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii11-17.
4.	Singh RP, Stratta RJ. Advances in immunosuppression for pancreas transplantation. Curr Opin Organ Transplant, 2008, 13(1): 79-84.
5.	Sutherland DE, Gores PF, Farney AC, et al. Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota. Am J Surg, 1993, 166(5): 456-491.
6.	Richter A, Davies DE, Alexander P. Growth inhibitory effects of FK506 and cyclosporin A independent of inhibition of calcineurin. Biochem Pharmacol, 1995, 49(3): 367-373.
7.	Boggi U, Vistoli F, Del Chiaro M, et al. Single-center, open, prospective, randomized pilot study comparing cyclosporine versus tacrolimus in simultaneous pancreas-kidney transplantation. Transplant Proc, 2004, 36(4): 1064-1066.
8.	Boggi U, Vistoli F, Del Chiaro M, et al. Neoral versus Prograf in simultaneous pancreas-kidney transplantation with portal venous drainage: Three-year results of a single-center, open-label, prospective, randomized pilot study. Transplant Proc, 2005, 37(6): 2641-2643.
9.	Bechstein WO, Malaise J, Saudek F, et al. Efficacy and safety of tacrolimus compared with cyclosporine microemulsion in primary simultaneous pancreas-kidney transplantation: 1-year results of a large multicenter trial. Transplantation, 2004, 77(8): 1221-1228.
10.	Saudek F, Malaise J, Boucek P, et al. Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in primary SPK transplantation: 3-year results of the Euro-SPK 001 trial. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii3-10.
11.	Woeste G, Wullstein C, Dette K, et al. Tacrolimus/mycophenolate mofetil vs cyclosporine A/Azathioprine after simultaneous pancreas and kidney transplantation: Five-year results of a randomized study. Transplant Proc, 2002, 34(5): 1920-1921.
12.	Schulz T, Konzack J , Büsing M. Mycophenolate mofet i l / prednisolone/single-shot ATG with tacrolimus or cyclosporine in pancreas/kidney transplantation: first results of an ongoing prospective randomized trial. Transplant Proc, 1999, 31(1-2): 591-592.
13.	Stegall MD, Simon M, Wachs ME, et al. Mycophenolate mofetil decreases rejection in simultaneous pancreas-kidney transplantation when combined with tacrolimus or cyclosporine. Transplantation, 1997, 64(12): 1695-1700.
14.	Schmied BM, Müller SA, Mehrabi A, et al. Immunosuppressive standards in simultaneous kidney-pancreas transplantation. Clin Transplant, 2006, 20(Suppl 17): 44-50.
15.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available at: www.cochranehandbook. org.
16.	Cochrane W. The combination of estimates from different experiments. Biometrics, 1954, 10(1): 101-129.
17.	Ye F, Ying-Bin X, Yu-Guo W, et al. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis. J Heart Lung Transplant, 2009, 28(1): 58-66.
18.	McAl i s ter VC, Haddad E, Renouf E, e t al . Cyclospor i n versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis. Am J Transplant, 2006, 6(7): 1578-1585.
19.	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. BMJ, 2005, 331(7520): 810.
20.	Drachenberg CB, Klassen DK, Weir MR, et al. Islet cell damage associated with tacrolimus and cyclosporine: morphological features in pancreas allograft biopsies and clinical correlation. Transplantation, 1999, 68(3): 396-402.
21.	Delis S, Dervenis C, Bramis J, et al. Vascular complications of pancreas transplantation. Pancreas, 2004, 28(24): 413-420.
22.	Steurer W, Malaise J, Mark W, et al. Spectrum of surgical complications after simultaneous pancreas-kidney transplantation in a prospectively randomized study of two immunosuppressive protocols. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii54-62.

1. Kelly WD, Lillehei RC, Merkel FK, et al. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery, 1967, 61(6): 827-837.
2. Knoll GA, Nichol G. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options. J Am Soc Nephrol, 2003, 14(2): 500-515.
3. Arbogast H, Malaise J, Illner WD, et al. Rejection after simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii11-17.
4. Singh RP, Stratta RJ. Advances in immunosuppression for pancreas transplantation. Curr Opin Organ Transplant, 2008, 13(1): 79-84.
5. Sutherland DE, Gores PF, Farney AC, et al. Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota. Am J Surg, 1993, 166(5): 456-491.
6. Richter A, Davies DE, Alexander P. Growth inhibitory effects of FK506 and cyclosporin A independent of inhibition of calcineurin. Biochem Pharmacol, 1995, 49(3): 367-373.
7. Boggi U, Vistoli F, Del Chiaro M, et al. Single-center, open, prospective, randomized pilot study comparing cyclosporine versus tacrolimus in simultaneous pancreas-kidney transplantation. Transplant Proc, 2004, 36(4): 1064-1066.
8. Boggi U, Vistoli F, Del Chiaro M, et al. Neoral versus Prograf in simultaneous pancreas-kidney transplantation with portal venous drainage: Three-year results of a single-center, open-label, prospective, randomized pilot study. Transplant Proc, 2005, 37(6): 2641-2643.
9. Bechstein WO, Malaise J, Saudek F, et al. Efficacy and safety of tacrolimus compared with cyclosporine microemulsion in primary simultaneous pancreas-kidney transplantation: 1-year results of a large multicenter trial. Transplantation, 2004, 77(8): 1221-1228.
10. Saudek F, Malaise J, Boucek P, et al. Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in primary SPK transplantation: 3-year results of the Euro-SPK 001 trial. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii3-10.
11. Woeste G, Wullstein C, Dette K, et al. Tacrolimus/mycophenolate mofetil vs cyclosporine A/Azathioprine after simultaneous pancreas and kidney transplantation: Five-year results of a randomized study. Transplant Proc, 2002, 34(5): 1920-1921.
12. Schulz T, Konzack J , Büsing M. Mycophenolate mofet i l / prednisolone/single-shot ATG with tacrolimus or cyclosporine in pancreas/kidney transplantation: first results of an ongoing prospective randomized trial. Transplant Proc, 1999, 31(1-2): 591-592.
13. Stegall MD, Simon M, Wachs ME, et al. Mycophenolate mofetil decreases rejection in simultaneous pancreas-kidney transplantation when combined with tacrolimus or cyclosporine. Transplantation, 1997, 64(12): 1695-1700.
14. Schmied BM, Müller SA, Mehrabi A, et al. Immunosuppressive standards in simultaneous kidney-pancreas transplantation. Clin Transplant, 2006, 20(Suppl 17): 44-50.
15. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available at: www.cochranehandbook. org.
16. Cochrane W. The combination of estimates from different experiments. Biometrics, 1954, 10(1): 101-129.
17. Ye F, Ying-Bin X, Yu-Guo W, et al. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis. J Heart Lung Transplant, 2009, 28(1): 58-66.
18. McAl i s ter VC, Haddad E, Renouf E, e t al . Cyclospor i n versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis. Am J Transplant, 2006, 6(7): 1578-1585.
19. 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. BMJ, 2005, 331(7520): 810.
20. Drachenberg CB, Klassen DK, Weir MR, et al. Islet cell damage associated with tacrolimus and cyclosporine: morphological features in pancreas allograft biopsies and clinical correlation. Transplantation, 1999, 68(3): 396-402.
21. Delis S, Dervenis C, Bramis J, et al. Vascular complications of pancreas transplantation. Pancreas, 2004, 28(24): 413-420.
22. Steurer W, Malaise J, Mark W, et al. Spectrum of surgical complications after simultaneous pancreas-kidney transplantation in a prospectively randomized study of two immunosuppressive protocols. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii54-62.

Chinese Journal of Evidence-Based Medicine

Tacrolimus versus Cyclosporine A for Simultaneous Pancreas-Kidney Transplant Recipients: A Meta-Analysis

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