title: Effectiveness and safety of calcineurin inhibitor withdrawal in kidney transplantation: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  The purpose was to compare the effectiveness and safety of calcineurin inhibitors (CNIs) withdrawal and continued therapies in kidney transplant recipients.
  
  
  METHODS
  We searched the PubMed, MEDLINE, Springer, Elsevier Science Direct, Cochrane Library and Google Scholar up to May 2014. Risk ratio (RR) or weighted mean difference (WMD) and their 95 % confidence intervals (CIs) were calculated in fixed-effects model or random-effects model when appropriate. Besides, sensitivity analysis was performed based on the addition of sirolimus in initial immunosuppression protocols.
  
  
  RESULTS
  Total seven studies with 1071 kidney transplant recipients received CNIs withdrawal therapy (experimental group) and 792 kidney transplant recipients received CNIs continued therapy (control group) were included in the meta-analysis. The overall estimates of acute rejection rate (RR = 1.64, 95 % CI: 1.19-2.27, P = 0.003), mean measured glomerular filtration rate (WMD = 9.50, 95 % CI = 2.96-16.03, P = 0.004), thrombocytopenia (RR = 3.39, 95 % CI: 2.27-5.05, P < 0.00001) and hypertension (RR = 0.56, 95 % CI: 0.40-0.78, P = 0.0006) showed that there were significant differences between the CNIs withdrawal and continued therapies in kidney transplant recipients, while no significant differences were found between groups in survival rate, graft survival rate, diabetes, hypercholesterolemia, hypertriglyceridemia and malignancies. In addition, two studies, in which sirolimus was not used in initial immunosuppression protocol, were excluded in sensitivity analysis and the results were still consistent with the overall analysis.
  
  
  CONCLUSIONS
  CNIs withdrawal therapy in kidney transplant recipients could significantly decrease risk of hypertension and improve glomerular filtration rate, accompanying with increased risk of acute rejection and thrombocytopenia, compared with the CNIs continued therapy.
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Bai
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Yeyong
authors.initials: Y
authors.lastname: Qian
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China. shibingyizxl@126.com.
authors.forename: Bingyi
authors.initials: B
authors.lastname: Shi
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Yuan
authors.affiliation: Department of Urology, Institute of Organ Transplantation of PLA, 309th Hospital of PLA, A17 Heishanhu Road, Haidian District, Beijing, 100091, China.
authors.forename: Lupeng
authors.initials: L
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic
chemical_list: D065095:Calcineurin Inhibitors
keywords: Calcineurin inhibitor; Kidney transplantation; Meta-analysis; Withdrawal therapy
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