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2018 ; 12
(ä): 417-428
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Risk factors for calcineurin inhibitor nephrotoxicity after renal
transplantation: a systematic review and meta-analysis
#MMPMID29535503
Xia T
; Zhu S
; Wen Y
; Gao S
; Li M
; Tao X
; Zhang F
; Chen W
Drug Des Devel Ther
2018[]; 12
(ä): 417-428
PMID29535503
show ga
BACKGROUND: Nephrotoxicity of calcineurin inhibitors (CNIs) is the major concern
for long-term allograft survival despite its predominant role in current
immunosuppressive regime after renal transplantation. CNI nephrotoxicity is
multifactorial with demographic, environmental, and pharmacogenetic flexibility,
whereas studies indicating risk factors for CNI nephrotoxicity obtained
incomplete or conflicting results. METHODS: A systematic review and meta-analysis
of risk factors for CNI nephrotoxicity was performed on all retrieved studies
through a comprehensive research of network database. Data were analyzed by
Review Manager 5.2 with heterogeneity assessed using the Cochrane Q and I(2)
tests. CNI nephrotoxicity was primarily indicated with protocol biopsy or
index-based clinical diagnosis, and the secondary outcome was defined as delayed
graft function. RESULTS: Twelve observational studies containing a total of 2,849
cases were identified. Donor age (odds ratio [OR], 1.01; 95% CI, 1.01-1.03;
p=0.02), recipient zero-time arteriosclerosis (OR, 1.44; 95% CI, 1.04-1.99;
p=0.03), and CYP3A5*3/*3 genotype (OR, 2.80; 95% CI, 2.63-2.98; p=0.00) were
confirmed as risk factors for CNI nephrotoxicity. Subgroup and sensitivity
analysis claimed donor age as a significant contributor in Asian and Caucasian
areas. CONCLUSION: Older donor age, recipient zero-time arteriosclerosis, and
CYP3A5*3/*3 genotype might add up the risk for CNI nephrotoxicity, which could be
interpreted into a robust biomarker system.