Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis - Archive ouverte HAL Access content directly
Journal Articles British Journal of Clinical Pharmacology Year : 2014

Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis

C. Dufays
  • Function : Author
Ségolène Gaillard
  • Function : Author
M. Redonnet
  • Function : Author
A. Roussoulieres
  • Function : Author
C. A. Gleissner
  • Function : Author
J. Groetzner
  • Function : Author
H. B. Lehmkuhl
  • Function : Author
L. Potena
  • Function : Author
L. Gullestad
  • Function : Author
M. Cantarovich
  • Function : Author
P. Boissonnat
  • Function : Author

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 I(2) = 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 I(2) = 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.

Dates and versions

hal-01859376 , version 1 (22-08-2018)

Identifiers

Cite

Catherine Cornu, C. Dufays, Ségolène Gaillard, François Gueyffier, M. Redonnet, et al.. Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis. British Journal of Clinical Pharmacology, 2014, 78 (1), pp.24-32. ⟨10.1111/bcp.12289⟩. ⟨hal-01859376⟩
30 View
0 Download

Altmetric

Share

Gmail Facebook X LinkedIn More