Ravanshad Yalda, Azarfar Anoush, Ravanshad Sahar, Naderi Nasab Malihe, Ghasemi Ali, Golsorkhi Mohaddeseh, Mostafavian Zahra, Esmaeeli Mohamad, Mehrad Majd Hassan
Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Kidney Dis. 2020 Mar;14(2):145-152.
There are some randomized trials which have already evaluated different calcineurin inhibitors (CNIs), especially comparing Tacrolimus and Cyclosporine, as immunosuppressant agents in children. However, their findings have been occasionally conflicting and thus debatable. Therefore, the evidence on safety and efficacy of immunosuppressive therapy after kidney transplantation in children has been inconclusive and argued to date. This study was aimed to compare the benefits and disadvantages of tacrolimus versus cyclosporine as the primary immunosuppression after renal transplantation in children.
A systematic review and meta-analysis was done. An electronic literature review was conducted to identify appropriate studies. The outcomes were presented as relative risk, with 95% confidence intervals.
Five qualified randomized controlled trials were included in this systematic review. Tacrolimus was insignificantly superior to cyclosporine considering the total effect size of graft loss (RR = 0.67, 95% CI: 0.40 - 1.11; P > .05) and acute rejection (RR = 0.79, 95% CI: 0.59 - 1.05; P > .05). On the contrary, cyclosporine seemed to be insignificantly superior to tacrolimus regarding mortality rate (RR = 1.06, 95% CI: 0.59 - 1.90; P > .05).
Admitting the study limitations mainly because of the nature and case study size of the included trials, it can be concluded from our systematic review results that Tacrolimus seems insignificantly superior to Cyclosporine respecting graft loss and acute rejection. However, Cyclosporine was shown to be insignificantly superior regarding mortality rate. However additional studies with a larger sample size are highly recommended.
已有一些随机试验评估了不同的钙调神经磷酸酶抑制剂（CNIs），尤其是比较他克莫司和环孢素作为儿童免疫抑制剂的效果。然而，他们的研究结果偶尔存在冲突，因此存在争议。因此，儿童肾移植后免疫抑制治疗的安全性和有效性证据至今尚无定论且存在争议。本研究旨在比较他克莫司与环孢素作为儿童肾移植后主要免疫抑制药物的利弊。
进行了系统评价和荟萃分析。通过电子文献检索确定合适的研究。结果以相对风险及95%置信区间表示。
本系统评价纳入了五项合格的随机对照试验。考虑移植失败的总体效应量（RR = 0.67，95% CI：0.40 - 1.11；P > 0.05）和急性排斥反应（RR = 0.79，95% CI：0.59 - 1.05；P > 0.05），他克莫司略优于环孢素。相反，在死亡率方面，环孢素似乎略优于他克莫司（RR = 1.06，95% CI：0.59 - 1.90；P > 0.05）。
鉴于本研究存在局限性，主要是由于纳入试验的性质和病例研究规模，从我们的系统评价结果可以得出，在移植失败和急性排斥反应方面，他克莫司似乎略优于环孢素。然而，在死亡率方面，环孢素略占优势。不过，强烈建议开展更多样本量更大的研究。
