Calcineurin-Inhibitor Minimization in Liver Transplant Patients with Calcineurin-Inhibitor-Related Renal Dysfunction A Meta-Analysis 英文参考文献.docVIP

Calcineurin-InhibitorMinimizationinLiverTransplant PatientswithCalcineurin-Inhibitor-RelatedRenal Dysfunction:AMeta-Analysis YuanKong.,DongpingWang.,YushuShang.,WenhuaLiang,XiaotingLing,ZhiyongGuo* ,Xiaoshun He* OrganTransplantCenter,FirstAffiliatedHospital,SunYat-senUniversity,Guangzhou,China Abstract Background:Introductionofcalcineurin-inhibitor(CNI)hasmadetransplantationamiracleinthepastcentury.However, thesideeffectsoflong-termuseofCNIturnouttobeoneofthemajorchallengesinthecurrentcentury.Amongthese, renal dysfunction attracts more and more attention. Herein, we undertook a meta-analysis to evaluate the efficacy and safetyofcalcineurin-inhibitor(CNI)minimizationprotocolsinlivertransplantrecipientswithCNI-relatedrenaldysfunction. Methods:Weincludedrandomizedtrialswithnoyearandlanguagerestriction.Alldatawereanalyzedusingrandomeffect modelbyReviewManager5.0.Theprimaryendpointswereglomerularfiltrationrate(GFR),serumcreatininelevel(sCr)and creatinine clearance rate (CrCl), and the secondary endpoints were acute rejection episodes, incidence of infection and patientsurvivalattheendoffollow-up. Results:GFRwassignificantlyimprovedinCNIminimizationgroupthaninroutineCNIregimengroup(Z=5.45,P,0.00001; I2=0%).Likely,sCrlevelwassignificantlylowerintheCNIminimizationgroup(Z=2.84,P=0.005;I2=39%).However,CrCl wasnotsignificantlyhigherintheCNIminimizationgroup(Z=1.59,P=0.11;I2=0%).Bothacuterejectionepisodesand patient survival were comparable between two groups (rejection: Z=0.01, P=0.99; I2=0%; survival: Z=0.28, P =0.78; I2=0%, respectively). However, current CNI minimization protocols may be related to a higher incidence of infections (Z=3.06,P=0.002;I2 =0%). Conclusion: CNI minimization can preserve or even improve renal function in liver transplant patients with renal impairment,whilesharingsimilarshorttermacuterejectionrateandpatientsurvivalwithroutineCNIregimen. Citation:KongY,WangD,ShangY,LiangW,LingX,etal.(2011)Calcineurin-InhibitorMinimizationinLiverTransplantPatientsw