Calcineurin Inhibitor Minimization, Conversion, Withdrawal, and Avoidance Strategies in Renal Transplantation: A Systematic Review and Meta-Analysis.

摘要: Despite their clinical efficacy, concerns about calcineurin inhibitor (CNI) toxicity make alternative regimens that reduce CNI exposure attractive for renal transplant recipients. In this systematic review and meta-analysis, we assessed four immunosuppression strategies (minimization, conversion, withdrawal, avoidance) designed to the impact of each on patient allograft survival, acute rejection function. We evaluated 92 comparisons from 88 randomized controlled trials found moderate- high-strength evidence suggesting minimization result in better outcomes compared with standard-dose regimens; moderate-strength indicating conversion a mammalian target rapamycin or belatacept was associated improved function but increased risk; planned withdrawal could despite an association risk. The base avoidance studies insufficient draw meaningful conclusions. applicability is limited by large number examining cyclosporine-based low-risk populations. Additional research needed tacrolimus-based higher risk Moreover, necessary clarify effect induction adjunctive agents should include more comprehensive consistent reporting patient-centered outcomes.