title: Meta-analysis of calcineurin-inhibitor-sparing regimens in kidney transplantation.
abstract: Calcineurin-inhibitor-sparing strategies in kidney transplantation may spare patients the adverse effects of these drugs, but the efficacy of these strategies is unknown. Here, we conduct a meta-analysis to assess outcomes associated with reducing calcineurin inhibitor exposure from the time of transplantation. We search Medline, Embase, and Cochrane Register of Controlled Trials for randomized controlled trials published between 1966 and 2010 that compared de novo calcineurin-inhibitor-sparing regimens to calcineurin-inhibitor-based regimens. In this analysis, we include 56 studies comprising data from 11337 renal transplant recipients. Use of the contemporary agents belatacept or tofacitinib, in combination with mycophenolate, decreased the odds of overall graft failure (OR 0.61; 95% CI 0.39-0.96; P = 0.03). Similarly, minimization of calcineurin inhibitors in combination with various induction and adjunctive agents reduces the odds of graft failure (OR 0.73; 95% CI 0.58-0.92; P = 0.009). Conversely, the use of inhibitors of mammalian target of rapamycin (mTOR), in combination with mycophenolate, increases the odds of graft failure (OR 1.43; 95% CI 1.08-1.90; P = 0.01). Calcineurin-inhibitor-sparing strategies are associated with less delayed graft function (OR 0.89; 95% CI 0.80-0.98; P = 0.02), improved graft function, and less new-onset diabetes. The more contemporary protocols did not seem to increase rates of acute rejection. In conclusion, this meta-analysis suggests that reducing exposure to calcineurin inhibitors immediately after kidney transplantation may improve clinical outcomes.
authors.affiliation: Renal Institute of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sharif
authors.forename: Shazia
authors.initials: S
authors.lastname: Shabir
authors.forename: Sourabh
authors.initials: S
authors.lastname: Chand
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.forename: Simon
authors.initials: S
authors.lastname: Ball
authors.forename: Richard
authors.initials: R
authors.lastname: Borrows
mesh_terms: D065095:Calcineurin Inhibitors; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival / Q000187:drug effects* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents