A systematic review of conversion from calcineurin inhibitor to mammalian target of rapamycin inhibitors for maintenance immunosuppression in kidney transplant recipients.

摘要: This was a systematic review of randomized controlled trials comparing delayed conversion mammalian target rapamycin inhibitors (mTORi) for calcineurin (CNIs) versus CNI continuation in kidney transplantation. Databases (2000–2012) and conference abstracts (2009–2012) were searched giving total 29 trials. Outcomes analyzed included GFR, graft loss, rejection adverse events expressed as weighted mean differences (WMDs) or risk ratios (RRs). Patients converted to mTORi up 1 year posttransplant intention-to-treat analysis had higher GFR compared with those remaining on (WMD 0.28 mL/min/1.73 m2, 95% confidence interval [CI] 0.21–0.36; I2 = 68%, p < 0.001). Stratifying by time type did not change the overall heterogeneity. For on-treatment population, associated (14.21 mL/min/1.73 m2, 10.34–18.08; I2 = 0%, p = 0.970) 2–5 years posttransplant. The at (RR 1.72, 1.34–2.22; I2 = 12%, p = 0.330). Discontinuation secondary more common patients mTORi, whereas incidence skin cancers cytomegalovirus infection lower mTORi. Conversion from is short-term improvements number studies but longer-term follow-up data patient survival are required.