Department of Nephrology, the First Affiliated Hospital of University of South China, Hengyang, China
Department of Diagnostic Ultrasound, the First Hospital of Changsha, Hengyang, China
Turk J Med Sci. 2021 Jun 28;51(3):1080-1091. doi: 10.3906/sag-1910-156.
BACKGROUND/AIM: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the comparison and its timing between mycophenolate mofetil (MMF) and calcineurin inhibitor (CNI) as maintenance immunosuppression for kidney transplant recipients.
The RCTs of MMF versus CNI as maintenance immunosuppression for kidney transplant recipients were searched from PubMed, Embase, Cochrane Central Register of Controlled Trials (CCRCT), and ClinicalTrials.gov. After screening relevant RCTs, two authors independently assessed the quality of included studies and performed a meta-analysis using RevMan5.3. Relative risk (RR) was used to report dichotomous data, while mean difference (MD) with 95% confidence interval (CI) was used to report continuous outcomes. The analysis was conducted using the random-effect model due to the expected heterogeneity among different studies. Four subgroups were allocated to compare MMF with CNI as maintenance immunosuppression: (1) after 3 months of CNI-based therapy, (2) after 6 months of CNI-based therapy, (3) after 12 months of CNI-based therapy, and (4) in recipients with allograft dysfunction.
Twelve RCTs with 950 renal transplant recipients were included. This meta-analysis presented the following results upon comparison between MMF and CNI as maintenance immunosuppression for kidney transplant recipients: (1) MMF significantly improved the glomerular filtration rate (GFR) not only in the comparison performed after 3, 6, or 12 months of CNI-based therapy but also in the comparison of recipients with allograft dysfunction, (2) MMF may increase the risk of acute rejection in the comparison performed after 3 months of CNI-based therapy, but no increase was noted in the comparison performed after 6 or 12 months of CNI- based therapy.
Our present meta-analysis suggested that MMF followed at least 6 months of CNI-based therapy is an effective maintenance immunosuppressive regimen for kidney transplant recipients to improve renal function but not increase rejection.
背景/目的：我们进行了一项系统评价和荟萃分析，以评估霉酚酸酯（MMF）与钙调磷酸酶抑制剂（CNI）作为肾移植受者维持性免疫抑制剂的比较及其时间。
从 PubMed、Embase、Cochrane 中央对照试验注册库（CCRCT）和 ClinicalTrials.gov 搜索 MMF 与 CNI 作为肾移植受者维持性免疫抑制剂的随机对照试验（RCT）。筛选相关 RCT 后，两名作者独立评估纳入研究的质量，并使用 RevMan5.3 进行荟萃分析。相对风险（RR）用于报告二分类数据，而均值差（MD）和 95%置信区间（CI）用于报告连续结果。由于不同研究之间存在预期异质性，因此采用随机效应模型进行分析。将四个亚组分配来比较 MMF 与 CNI 作为维持性免疫抑制剂：（1）在基于 CNI 的治疗 3 个月后，（2）在基于 CNI 的治疗 6 个月后，（3）在基于 CNI 的治疗 12 个月后，以及（4）在同种异体移植物功能障碍的受者中。
纳入了 12 项 RCT，共 950 例肾移植受者。这项荟萃分析比较了 MMF 与 CNI 作为肾移植受者维持性免疫抑制剂的结果如下：（1）MMF 不仅在基于 CNI 的治疗 3、6 或 12 个月后进行的比较中显著改善肾小球滤过率（GFR），而且在同种异体移植物功能障碍受者的比较中也如此，（2）MMF 在基于 CNI 的治疗 3 个月后进行的比较中可能会增加急性排斥反应的风险，但在基于 CNI 的治疗 6 或 12 个月后进行的比较中没有增加。
我们的荟萃分析表明，在至少 6 个月的 CNI 基础治疗后使用 MMF 是一种有效的肾移植受者维持性免疫抑制方案，可以改善肾功能而不会增加排斥反应。
