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Everolimus with early withdrawal or reduced‐dose calcineurin inhibitors improves renal function in liver transplant recipients: A systematic review and meta‐analysis
Author(s) -
Lin Michael,
Mittal Sahil,
Sahebjam Farhad,
Rana Abbas,
Sood Gagan K.
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12872
Subject(s) - medicine , everolimus , calcineurin , urology , nephrotoxicity , renal function , liver transplantation , immunosuppression , randomized controlled trial , transplantation , tacrolimus , relative risk , meta analysis , surgery , kidney , confidence interval
Calcineurin inhibitors ( CNI ) are the mainstay of immunosuppression after liver transplantation ( LT ), but CNI s are associated with significant nephrotoxicity. Recently, mTOR inhibitors such as sirolimus and everolimus ( EVR ) have been used with or without CNI s in LT recipients for their renal‐sparing effect. We conducted a systematic review and meta‐analysis of randomized controlled trials ( RCT ) that examined the effect of EVR with CNI minimization or withdrawal on renal function in LT recipients. RCT of primary adult LT recipients with baseline GFR >30 mL /min who received EVR with CNI minimization or withdrawal were included. Four RCT s ( EVR n=465, control n=428) were included. In three RCT s, EVR was initiated 4 weeks following LT ; these studies were used to assess the primary outcome. All four studies were used to assess the secondary outcomes. Based on this study, EVR use with CNI minimization in LT recipients is associated with improved renal function at 12 months by GFR of 10.2 mL /min (95% CI : 2.75‐17.8). EVR use was not associated with an increased risk of biopsy‐proven acute rejection ( RR 0.68, 95% CI : 0.31‐1.46), graft loss ( RR 1.60, 95% CI : 0.51‐5.00), or mortality ( RR 1.34, 95% CI 0.62‐2.90). However, it was associated with an increased risk of overall infections ( RR 1.45, 95% CI : 1.10‐1.91).