Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis
Aims: Calcineurin inhibitors (CNIs) taken after heart transplantation lead to excellent short-term outcomes, but long-term use may cause chronic nephrotoxicity. Our aim was to identify, appraise, select and analyse all high-quality research evidence relevant to the question of the clinical impact of...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2014
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| In: |
British journal of clinical pharmacology
Year: 2014, Volume: 78, Issue: 1, Pages: 24-32 |
| ISSN: | 1365-2125 |
| DOI: | 10.1111/bcp.12289 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/bcp.12289 Verlag, lizenzpflichtig, Volltext: https://bpspubs.onlinelibrary.wiley.com/doi/abs/10.1111/bcp.12289 
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| Author Notes: | Catherine Cornu, Christophe Dufays, Ségolène Gaillard, François Gueyffier, Michel Redonnet, Laurent Sebbag, Ana Roussoulières, Christian A. Gleissner, Jan Groetzner, Hans B. Lehmkuhl, Luciano Potena, Lars Gullestad, Marcelo Cantarovich & Pascale Boissonnat |
| Summary: | Aims: Calcineurin inhibitors (CNIs) taken after heart transplantation lead to excellent short-term outcomes, but long-term use may cause chronic nephrotoxicity. Our aim was to identify, appraise, select and analyse all high-quality research evidence relevant to the question of the clinical impact of CNI-sparing strategies in heart transplant patients. Methods: We carried out a systematic review and meta-analysis of randomized controlled trials on CNI reduction in heart transplant recipients. Primary outcomes were kidney function and acute rejection after 1 year. Secondary outcomes included graft loss, all-cause mortality and adverse events. Results: Eight open-label studies were included, with 723 patients (four tested de novo CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor reduction did not improve creatinine clearance at 12 months 5.46 [−1.17, 12.03] P = 0.32 I2 = 65.4%. Acute rejection at 12 months (55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates (55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI groups. There was significant benefit on creatinine clearance in patients with impaired renal function at 6 months [+12.23 (+5.26, +18.82) ml min−1, P = 0.0003] and at 12 months 4.63 [−4.55, 13.82] P = 0.32 I2 = 75%. Conclusions: This meta-analysis did not demonstrate a favourable effect of CNI reduction on kidney function, but there was no increase in acute rejection. To provide a better analysis of the influence of CNI reduction patterns and associated treatments, a meta-analysis of individual patient data should be performed. |
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| Item Description: | Accepted article published online: 20 November 2013 Gesehen am 23.09.2020 |
| Physical Description: | Online Resource |
| ISSN: | 1365-2125 |
| DOI: | 10.1111/bcp.12289 |