Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients

• Verfasst von: Cornu, Catherine [VerfasserIn]
• Verfasst von: Gleißner, Christian A. [VerfasserIn]
• Titel: Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients
• Titelzusatz: a systematic review and meta-analysis
• Verf.angabe: 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
• Jahr: 2014
• Umfang: 9 S.
• Fussnoten: Accepted article published online: 20 November 2013 ; Gesehen am 23.09.2020
• Titel Quelle: Enthalten in: British journal of clinical pharmacology
• Ort Quelle: Oxford : Wiley-Blackwell, 1974
• Jahr Quelle: 2014
• Band/Heft Quelle: 78(2014), 1, Seite 24-32
• ISSN Quelle: 1365-2125
• DOI: doi:10.1111/bcp.12289
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: calcineurin inhibitor
• Sach-SW: heart transplantation
• Sach-SW: meta-analysis
• Sach-SW: renal function
• K10plus-PPN: 1733593306

Abstract

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.