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2017 ; 7
(2
): 144-151
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Systemic meta-analysis assessing the short term applicability of early conversion
to mammalian target of rapamycin inhibitors in kidney transplant
#MMPMID28507917
Kumar J
; Reccia I
; Kusano T
; Julie BM
; Sharma A
; Halawa A
World J Transplant
2017[Apr]; 7
(2
): 144-151
PMID28507917
show ga
AIM: To consolidate the present evidence of effectiveness in renal functioning
and graft survival following early introduction of mammalian target of rapamycin
(mTOR) inhibitors with or without calcineurin inhibitors (CNIs) in renal
transplant recipients. METHODS: We analysed the current literature following
PROSPERO approval describing the role of immunosuppressive agent, mTOR inhibitors
as an alternative to CNI within six months of renal transplant by searching the
PubMed, EMBASE, Cochrane, Crossref, and Scopus using MeSH terms. RESULTS: Six
articles of early withdrawal of CNI and introduction of mTOR-inhibitors within
six months of renal transplantation were sought. Glomerular filtration rate (GFR)
and serum creatinine were significantly better in mTOR inhibitor group with
equivalent survival at 12 mo, even though Biopsy Proven Acute rejection was
significantly higher in mTOR-inhibitor group. CONCLUSION: The evidence reviewed
in this meta-analysis suggests that early introduction mTOR-inhibitors
substantial CNI minimization. The mTOR inhibitors such as everolimus and
sirolimus, due to their complementary mechanism of action and favourable
nephrotoxicity profile; better glomerular filtration, lower serum creatinine with
equivalent survival. Having said that, due to the higher rejection rate, may
influence the use of these regimens to patients with moderate to high
immunological risk patients.