title: Safety of immunosuppressive drugs used as maintenance therapy in kidney transplantation: a systematic review and meta-analysis.
abstract: To evaluate the safety of regimens containing calcineurin inhibitors (CNI), proliferation signal inhibitors (TOR-I) and antimetabolites, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies. A total of 4,960 citations were identified in our electronic search and 14 additional articles were identified through hand searching. Forty-eight articles (11,432 participants) from 42 studies (38 RCTs and four cohorts) met the inclusion criteria. Meta-analysis results revealed the following: (i) tacrolimus was associated with an increased risk for diabetes and lower risk of dyslipidemia, compared to cyclosporine; (ii) mycophenolate mofetil (MMF) was associated with increased risk for total infections, abdominal pain, diarrhea and vomiting, compared with azathioprine; (iii) sirolimus was associated with higher risk of anemia, diabetes, dyslipidemia, lymphoceles and withdrawal compared to tacrolimus or cyclosporine, and cyclosporine was associated with an increased risk of CMV infection; (iv) the combination of CNI with antimetabolites was associated with more adverse events than CNI alone; (v) TOR-I was related to more adverse events than MMF. The data observed in this meta-analysis are similar to those describe by others authors; thus, the choice of treatment must be made by the clinical staff based on specific patient characteristics.
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Belo Horizonte/MG, Brazil. celline.cardoso@gmail.com.
authors.forename: Celline Cardoso
authors.initials: CC
authors.lastname: Almeida
authors.forename: Micheline Rosa
authors.initials: MR
authors.lastname: Silveira
authors.forename: Vânia Eloisa
authors.initials: VE
authors.lastname: de Araújo
authors.forename: Livia Lovato Pires
authors.initials: LL
authors.lastname: de Lemos
authors.forename: Juliana
authors.initials: J
authors.lastname: de Oliveira Costa
authors.forename: Carlos Augusto Lins
authors.initials: CA
authors.lastname: Reis
authors.forename: Francisco
authors.initials: F
authors.lastname: de Assis Acurcio
authors.forename: Maria
authors.initials: M
authors.lastname: das Gracas Braga Ceccato