Chao Sheng, Jia Lei, Zhu Kejing, Chen Luobei, Niu Yulin
Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Front Pharmacol. 2023 Oct 4;14:1226647. doi: 10.3389/fphar.2023.1226647. eCollection 2023.
Tacrolimus formulation affects the outcomes of a renal transplant, while the effect of its immediate- to extended-release conversion remains controversial. This meta-analysis aimed to compare the renal function before and after tacrolimus immediate- to extended-release conversion in renal transplant patients. PubMed, Cochrane, Embase, CNKI, CQVIP, and Wanfang databases were searched for articles regarding the effect of tacrolimus conversion from immediate- to extended-release formulation on renal function in renal transplant patients. The data on serum creatinine (Scr) or the estimated glomerular filtration rate (eGFR) before and after conversion were extracted and analyzed. Ten studies with 743 renal transplant patients were included. Scr was reduced after conversion versus before conversion [mean difference (MD) (95% confidence interval (CI)): -8.00 (-14.33; -1.66) μmol/L, = 0.01]. However, eGFR only showed an increased trend after conversion versus before conversion (MD (95% CI): 2.21 (-1.62, 6.03) mL/min/1.73 m, = 0.26) but without statistical significance. Furthermore, in patients with a follow-up duration ≥48 weeks, Scr was decreased after conversion versus before conversion ( = 0.005), but eGFR remained unchanged ( = 0.68). However, in patients with a follow-up duration <48 weeks, both Scr ( = 0.36) and eGFR ( = 0.24) were not different before conversion versus after conversion. Moreover, publication bias risk was low, and robustness assessed by sensitivity analysis was generally good. This meta-analysis favors studies indicating that the conversion of tacrolimus from an immediate-release to an extended-release formulation could improve the kidney function to some extent in renal transplant patients, and this advancement may be related to the administration period.
他克莫司剂型会影响肾移植的结果，而其从速释剂型转换为缓释剂型的效果仍存在争议。这项荟萃分析旨在比较肾移植患者他克莫司从速释剂型转换为缓释剂型前后的肾功能。检索了PubMed、Cochrane、Embase、中国知网、维普资讯和万方数据库中关于他克莫司从速释剂型转换为缓释剂型对肾移植患者肾功能影响的文章。提取并分析了转换前后血清肌酐（Scr）或估计肾小球滤过率（eGFR）的数据。纳入了10项研究，共743例肾移植患者。与转换前相比，转换后Scr降低[平均差（MD）（95%置信区间（CI））：-8.00（-14.33；-1.66）μmol/L，P = 0.01]。然而，与转换前相比，转换后eGFR仅呈现上升趋势（MD（95%CI）：2.21（-1.62，6.03）mL/min/1.73m²，P = 0.26），但无统计学意义。此外，在随访时间≥48周的患者中，与转换前相比，转换后Scr降低（P = 0.005），但eGFR保持不变（P = 0.68）。然而，在随访时间<48周的患者中，转换前后Scr（P = 0.36）和eGFR（P = 0.24）均无差异。此外，发表偏倚风险较低，通过敏感性分析评估的稳健性总体良好。这项荟萃分析支持以下研究结果：他克莫司从速释剂型转换为缓释剂型可在一定程度上改善肾移植患者的肾功能，且这种改善可能与给药时间有关。
