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; 剂量; 肾移植; Meta分析

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【摘要】目的 评价肾移植术后他克莫司（TAC）低剂量对比常规剂量干预的疗效和安全性。方法检索MEDLINE、EMbase、SCI、CBM、Cochrane图书馆，纳入肾移植术后TAC低剂量对比常规剂量免疫抑制治疗的随机对照试验（RCT）。检索时间从各个数据库建库至2009年12月，对纳入研究进行方法学质量评价和Meta分析。结果纳入3个RCT，其中A级研究2个，B级研究1个。分析结果显示:两组急性排斥反应发生率比较，无统计学意义[RR=1.39， 95%CI(0.64， 3.01)]；肾小球滤过率、受者/移植物生存率和纳入分析的安全性指标差异均无统计学意义。结论基于当前临床证据，肾移植术后TAC低剂量与常规剂量干预相比，近期疗效和安全性相似；远期结果尚需进一步研究探讨。
【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.	吴斌, 柳汝明, 唐尧. 肾移植术后低剂量与常规剂量环孢素A比较进行免疫抑制治疗有效性与安全性的Meta分析[J]. 中国循证医学杂志, 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. 吴斌, 柳汝明, 唐尧. 肾移植术后低剂量与常规剂量环孢素A比较进行免疫抑制治疗有效性与安全性的Meta分析[J]. 中国循证医学杂志, 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

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