Comparison of Sirolimus Combined With Tacrolimus and Mycophenolate Mofetil Combined With Tacrolimus in Kidney Transplantation Recipients: A Meta-Analysis

Gao, Li; Xu, Fen; Cheng, Huaiping; Liu, J.

doi:10.1016/j.transproceed.2018.08.056

Cited by 10 publications

(8 citation statements)

References 31 publications

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“…The effect on graft function as estimated with the eGFR was also similar between both groups. Our study corroborates the meta-analysis of Gao et al [25], indicating that mTOR inhibitors may offer an equally effective treatment option for patients suffering from toxic-…”

Section: Discussionsupporting

confidence: 91%

“…In contrast to this, a meta-analysis by Liu et al [ 24 ] in 2016 showed that conversion from CNI to everolimus led to improved eGFR, but was associated with an increased risk of acute rejection at 1 year. In contrast, concerning sirolimus, Gao et al [ 25 ] showed no significant differences in terms of acute rejection when sirolimus was combined with tacrolimus compared to when mycophenolate was combined with tacrolimus. Likewise, no significant differences were found regarding graft survival, infectious complications, anemia, and seroma [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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A systematic review and meta-analysis comparing everolimus and calcineurin inhibitors (CNIs) to mycophenolate and CNIs in kidney transplant patients

Vergara-Rejante

Tanhui

Alolod

2023

Korean J Transplant

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Background: This study compared everolimus and mycophenolate mofetil, each paired with calcineurin inhibitors (CNIs) and used with or without steroids, for maintaining immunosuppression in kidney transplant (KT) patients. Methods: Relevant studies published before August 21, 2022 were retrieved from PubMed, the Cochrane Central Register of Controlled Trials, and the gray literature. The risk of bias was assessed independently using the revised Cochrane risk of bias assessment tool (RoB 2). RevMan ver. 5.4 was used to calculate the risk ratios (RRs) with corresponding 95% confidence intervals (CIs) for biopsy-proven acute rejection, death, and infection. The mean difference (MD) was used to compare the estimated glomerular filtration rate (eGFR) between the groups. Results: Sixteen randomized controlled trials with a total of 5,403 patients were synthesized to compare everolimus (n=2,763) with mycophenolate (n=2,542) for maintaining post-KT immunosuppression. The meta-analysis showed no significant difference in the risk for biopsy-proven acute rejection (RR=1.12; 95% CI, 0.92-1.35; I 2 =29%) and death (RR=0.85; 95% CI, 0.63-1.16; I 2 =0%). The eGFR had no significant difference between the two groups (MD=0.93; 95% CI, −2.25 to 4.1; I 2 =84%). The risk for any infection was significantly higher in the mycophenolate group than in the everolimus group (RR=0.83; 95% CI, 0.73−0.93; I 2 =66%). Conclusions: Our meta-analysis showed that when paired with a CNI, everolimus and mycophenolate had no difference in risk for biopsy-proven acute rejection, death, or increase in eGFR. However, the mycophenolate group exhibited a significantly higher risk of infection.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis comparing everolimus and calcineurin inhibitors (CNIs) to mycophenolate and CNIs in kidney transplant patients

Vergara-Rejante

Tanhui

Alolod

2023

Korean J Transplant

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“…Among the six cases of oral lesion associated by drug toxicity in renal transplant recipients, reported in the literature, four involved patients are taking tacrolimus in combination with MMF 10,13–15 . Studies found a reduction in the rates of acute allograft rejection and mortality among renal transplant recipients on tacrolimus plus MMF compared to those on other immunosuppressive regimens 24–25 . In our case, the patient had already presented many episodes of graft rejection, which made the decision to reduce the dose of MPA difficult.…”

Section: Discussionmentioning

confidence: 72%

Diagnosis and management of oral ulcerations associated with mycophenolate mofetil in kidney transplantation

Tenório

Tuma

Martins

et al. 2020

Special Care in Dentistry

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Aims The final diagnosis of oral mucosal ulcerations in solid organ transplant recipients represents a challenge. We describe a unique case of oral ulceration related to mycophenolate mofetil (MMF) toxicity, 11 years after kidney transplantation, whose dose reduction was sufficient to resolve it. Methods and results A 54‐year‐old female patient, who underwent kidney transplantation 11 years ago, presents multiple ulcers on the buccal mucosa bilaterally, soft palate and tongue dorsum, for 8 months, with moderate pain. The diagnosis of oral ulcerations associated with MMF therapy was assumed by excluding infection and malignancy diagnosis. After MMF dose reduction, the oral ulcers healed utterly. Conclusions MMF toxicity manifested as oral ulcers. Reduction or discontinuation of MMF therapy should be considered in a patient with refractory oral ulcers and a negative workup for other causes.

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“…It has dethroned cyclosporine, the first calcineurin inhibitor introduced in kidney transplantation in the1980s . Currently, 94% of kidney transplant recipients (KTRs) are discharged after transplantation with a CNI‐based immunosuppressive regimen and more than of 90% of them receive tacrolimus as an anticalcineurin instead of cyclosporine . Moreover, the KDIGO (Kidney Disease Improving Global Outcomes) already suggested in 2009 that tacrolimus be the first‐line CNI used in kidney transplantation (KT) as initial and long‐term maintenance immunosuppressive therapy associated with an antiproliferative agent, with or without corticosteroids .…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus: 20 years of use in adult kidney transplantation. What we should know about its nephrotoxicity

Bentata

2019

Artificial Organs

100

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Tacrolimus (or FK506), a calcineurin inhibitor (CNI) introduced in field of transplantation in the 1990s, is the cornerstone of most immunosuppressive regi mens in solid organ transplantation. Its use has revolutionized the future of kidney transplantation (KT) and has been associated with better graft survival, a lower in cidence of rejection, and improved drug tolerance with fewer side effects compared to cyclosporine. However, its monitoring remains complicated and underexposure increases the risk of rejection, whereas overexposure increases the risk of adverse effects, primarily nephrotoxicity, neurotoxicity, infections, malignancies, diabetes, and gastrointestinal complaints. Tacrolimus nephrotoxicity can be nonreversible and can lead to kidney graft loss, and its diagnosis is therefore best made with reference to the clinical context and after exclusion of other causes of graft dysfunction. Many factors contribute to its development including: systemic levels of tacrolimus; local renal exposure to tacrolimus; exposure to metabolites of tacrolimus; local susceptibil ity factors for CNI nephrotoxicity independent of systemic or local tacrolimus levels, such as the age of a kidney; local renal P-glycoprotein, local intestinal and hepatic cytochrome P450A3, and renin angiotensin system activation. The aim of this review is to describe the pharmacokinetics, pharmacodynamics, and mechanisms of acute and chronic tacrolimus nephrotoxicity in adult KT. K E Y W O R D Sacute,

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Comparison of Sirolimus Combined With Tacrolimus and Mycophenolate Mofetil Combined With Tacrolimus in Kidney Transplantation Recipients: A Meta-Analysis

Cited by 10 publications

References 31 publications

A systematic review and meta-analysis comparing everolimus and calcineurin inhibitors (CNIs) to mycophenolate and CNIs in kidney transplant patients

A systematic review and meta-analysis comparing everolimus and calcineurin inhibitors (CNIs) to mycophenolate and CNIs in kidney transplant patients

Diagnosis and management of oral ulcerations associated with mycophenolate mofetil in kidney transplantation

Tacrolimus: 20 years of use in adult kidney transplantation. What we should know about its nephrotoxicity

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