Yan Liu1, Mao-Sheng Yang, Jian-Yong Yuan. 1. Department of Clinical Pharmacy, Nephrology and Pharmaceutical Chemistry, School of Pharmacy, Chongqing Medical University, Chongqing, 400016, China. cqliuyan2012@gmail.com
Abstract
PURPOSE: Data on the utilization of immunosuppressants and incidences of cardiovascular complications after kidney transplantation are generally lacking in China. The objectives of this systematic review and analysis were to investigate the hypothesis that tacrolimus and cyclosporine have different effects on the incidences of cardiovascular complications among Chinese patients after kidney transplantation. METHODS: A comprehensive database research was performed in PubMed and CMB-disc. Random effect models and meta-regression were used for data analysis. Eleven eligible studies were retrieved (7 comparative studies and 4 conversion studies). RESULTS: There were 838 participants from the eligible studies. The incidences of drug-related hypertension, dyslipidemia and hyperglycemia were compared between tacrolimus and cyclosporine groups. Significant different odds ratios for dyslipidemia (40 vs. 20 %, OR 2.72) and hypertension (63 vs. 37 %, OR 2.93), but not for hyperglycemia (11 vs. 15 %, OR 0.705) were noted between patients receiving cyclosporine and tacrolimus containing regimens. The secondary analysis including comparative studies revealed a similar acute rejection rate, but significantly improved renal functions, lipid profiles and lower liver toxicity associated with tacrolimus. Significant reversal of hypertension and dyslipidemia was also noted in the analysis of the conversion studies. CONCLUSIONS: A significant association between immunosuppressant use and cardiovascular complications was identified among Chinese patients after kidney transplantation. Patients receiving cyclosporine-containing regimens and/or with chronic allograft nephropathy should be closely monitored for potential cardiovascular complications.
PURPOSE: Data on the utilization of immunosuppressants and incidences of cardiovascular complications after kidney transplantation are generally lacking in China. The objectives of this systematic review and analysis were to investigate the hypothesis that tacrolimus and cyclosporine have different effects on the incidences of cardiovascular complications among Chinese patients after kidney transplantation. METHODS: A comprehensive database research was performed in PubMed and CMB-disc. Random effect models and meta-regression were used for data analysis. Eleven eligible studies were retrieved (7 comparative studies and 4 conversion studies). RESULTS: There were 838 participants from the eligible studies. The incidences of drug-related hypertension, dyslipidemia and hyperglycemia were compared between tacrolimus and cyclosporine groups. Significant different odds ratios for dyslipidemia (40 vs. 20 %, OR 2.72) and hypertension (63 vs. 37 %, OR 2.93), but not for hyperglycemia (11 vs. 15 %, OR 0.705) were noted between patients receiving cyclosporine and tacrolimus containing regimens. The secondary analysis including comparative studies revealed a similar acute rejection rate, but significantly improved renal functions, lipid profiles and lower liver toxicity associated with tacrolimus. Significant reversal of hypertension and dyslipidemia was also noted in the analysis of the conversion studies. CONCLUSIONS: A significant association between immunosuppressant use and cardiovascular complications was identified among Chinese patients after kidney transplantation. Patients receiving cyclosporine-containing regimens and/or with chronic allograft nephropathy should be closely monitored for potential cardiovascular complications.
Authors: Brian J Nankivell; Richard J Borrows; Caroline L-S Fung; Philip J O'Connell; Richard D M Allen; Jeremy R Chapman Journal: N Engl J Med Date: 2003-12-11 Impact factor: 91.245