PURPOSE: We conducted a systematic review of randomized trials to compare the benefits and harms of tacrolimus versus cyclosporine as primary immunosuppression after heart transplantation. METHODS AND RESULTS: We searched electronic databases and bibliographies up to April 2010. Our review followed the Cochrane and PRISMA guidelines. The meta-analysis included 10 randomized trials with 952 patients. Tacrolimus was significantly superior to cyclosporine (both formula-combined) with regard to hypertension (relative risk [RR] 0.8; 95% confidence interval [CI] 0.69-0.93, p = 0.003), hyperlipidaemia (RR 0.57; 95% CI 0.44-0.74, p < 0.0001), hirsutism (RR 0.17 95% CI 0.04-0.62, p = 0.008), and gingival hyperplasia (RR 0.07 95% CI 0.01-0.37, p = 0.002). No significant differences between the two calcineurin inhibitors were found with regard to acute rejections causing haemodynamic instability, diabetes, renal dysfunction, infection, malignancy, or neurotoxicity. Tacrolimus was significantly superior to microemulsion cyclosporine with regard to mortality (RR 0.64; 95% CI 0.42-0.96, p = 0.03), acute severe biopsy-proven rejection (RR 0.71; 95% CI 0.56-0.90, p = 0.004), hyperlipidaemia (RR 0.57; 95% CI 0.41-0.79, p = 0.0009), hirsutism (RR 0.17 95% CI 0.04-0.62, p = 0.008), and gingival hyperplasia (RR 0.07; 95% CI 0.01-0.37, p = 0.002). Tacrolimus was significantly superior to oil-based cyclosporine with regard to hypertension (RR 0.66; 95% CI 0.54-0.80, p < 0.0001), and hyperlipidaemia (RR 0.57; 95% CI 0.38-0.87, p = 0.009). CONCLUSION: Tacrolimus seems to be superior to cyclosporine in heart transplant patients with regard to hypertension, hyperlipidaemia, gingival hyperplasia and hirsutism. In addition, tacrolimus seems to be superior to microemulsion cyclosporine in heart transplant patients with regard to a number of outcomes, including death. More trials with a low risk of bias are needed to determine if the results of the present meta-analysis can be confirmed.
PURPOSE: We conducted a systematic review of randomized trials to compare the benefits and harms of tacrolimus versus cyclosporine as primary immunosuppression after heart transplantation. METHODS AND RESULTS: We searched electronic databases and bibliographies up to April 2010. Our review followed the Cochrane and PRISMA guidelines. The meta-analysis included 10 randomized trials with 952 patients. Tacrolimus was significantly superior to cyclosporine (both formula-combined) with regard to hypertension (relative risk [RR] 0.8; 95% confidence interval [CI] 0.69-0.93, p = 0.003), hyperlipidaemia (RR 0.57; 95% CI 0.44-0.74, p < 0.0001), hirsutism (RR 0.17 95% CI 0.04-0.62, p = 0.008), and gingival hyperplasia (RR 0.07 95% CI 0.01-0.37, p = 0.002). No significant differences between the two calcineurin inhibitors were found with regard to acute rejections causing haemodynamic instability, diabetes, renal dysfunction, infection, malignancy, or neurotoxicity. Tacrolimus was significantly superior to microemulsion cyclosporine with regard to mortality (RR 0.64; 95% CI 0.42-0.96, p = 0.03), acute severe biopsy-proven rejection (RR 0.71; 95% CI 0.56-0.90, p = 0.004), hyperlipidaemia (RR 0.57; 95% CI 0.41-0.79, p = 0.0009), hirsutism (RR 0.17 95% CI 0.04-0.62, p = 0.008), and gingival hyperplasia (RR 0.07; 95% CI 0.01-0.37, p = 0.002). Tacrolimus was significantly superior to oil-based cyclosporine with regard to hypertension (RR 0.66; 95% CI 0.54-0.80, p < 0.0001), and hyperlipidaemia (RR 0.57; 95% CI 0.38-0.87, p = 0.009). CONCLUSION:Tacrolimus seems to be superior to cyclosporine in heart transplant patients with regard to hypertension, hyperlipidaemia, gingival hyperplasia and hirsutism. In addition, tacrolimus seems to be superior to microemulsion cyclosporine in heart transplant patients with regard to a number of outcomes, including death. More trials with a low risk of bias are needed to determine if the results of the present meta-analysis can be confirmed.
Authors: B Reichart; B Meiser; M Viganò; M Rinaldi; M Yacoub; N R. Banner; I Gandjbakhch; R Dorent; R Hetzer; M Hummel Journal: J Heart Lung Transplant Date: 2001-02 Impact factor: 10.247
Authors: Susan Stewart; Gayle L Winters; Michael C Fishbein; Henry D Tazelaar; Jon Kobashigawa; Jacki Abrams; Claus B Andersen; Annalisa Angelini; Gerald J Berry; Margaret M Burke; Anthony J Demetris; Elizabeth Hammond; Silviu Itescu; Charles C Marboe; Bruce McManus; Elaine F Reed; Nancy L Reinsmoen; E Rene Rodriguez; Alan G Rose; Marlene Rose; Nicole Suciu-Focia; Adriana Zeevi; Margaret E Billingham Journal: J Heart Lung Transplant Date: 2005-06-20 Impact factor: 10.247
Authors: J A Kobashigawa; L W Miller; S D Russell; G A Ewald; M J Zucker; L R Goldberg; H J Eisen; K Salm; D Tolzman; J Gao; W Fitzsimmons; R First Journal: Am J Transplant Date: 2006-06 Impact factor: 8.086
Authors: B M Meiser; P Uberfuhr; A Fuchs; D Schmidt; M Pfeiffer; D Paulus; C Schulze; S Wildhirt; W V Scheidt; C Angermann; V Klauss; S Martin; H Reichenspurner; E Kreuzer; B Reichart Journal: J Heart Lung Transplant Date: 1998-08 Impact factor: 10.247
Authors: B Reichart; B Meiser; M Viganò; M Rinaldi; L Martinelli; M Yacoub; N R Banner; I Gandjbakhch; R Dorent; R Hetzer; M Hummel Journal: J Heart Lung Transplant Date: 1998-08 Impact factor: 10.247
Authors: Violette Gijsen; Seema Mital; Ron H van Schaik; Offie P Soldin; Steven J Soldin; Ilse P van der Heiden; Irena Nulman; Gideon Koren; Saskia N de Wildt Journal: J Heart Lung Transplant Date: 2011-09-17 Impact factor: 10.247
Authors: Anne B Taegtmeyer; Jane B Breen; John Smith; Paula Rogers; Gerd A Kullak-Ublick; Magdi H Yacoub; Nicholas R Banner; Paul J R Barton Journal: J Cardiovasc Transl Res Date: 2011-03-29 Impact factor: 4.132