Impact of the Reduction of Calcineurin Inhibitors on Renal Function in Heart Transplant Patients: a Systematic Review and Meta-analysis
Overview
Authors
Affiliations
Aims: Calcineurin inhibitors (CNIs) taken after heart transplantation lead to excellent short-term outcomes, but long-term use may cause chronic nephrotoxicity. Our aim was to identify, appraise, select and analyse all high-quality research evidence relevant to the question of the clinical impact of CNI-sparing strategies in heart transplant patients.
Methods: We carried out a systematic review and meta-analysis of randomized controlled trials on CNI reduction in heart transplant recipients. Primary outcomes were kidney function and acute rejection after 1 year. Secondary outcomes included graft loss, all-cause mortality and adverse events.
Results: Eight open-label studies were included, with 723 patients (four tested de novo CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor reduction did not improve creatinine clearance at 12 months 5.46 [-1.17, 12.03] P = 0.32 I(2) = 65.4%. Acute rejection at 12 months (55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates (55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI groups. There was significant benefit on creatinine clearance in patients with impaired renal function at 6 months [+12.23 (+5.26, +18.82) ml min(-1) , P = 0.0003] and at 12 months 4.63 [-4.55, 13.82] P = 0.32 I(2) = 75%.
Conclusions: This meta-analysis did not demonstrate a favourable effect of CNI reduction on kidney function, but there was no increase in acute rejection. To provide a better analysis of the influence of CNI reduction patterns and associated treatments, a meta-analysis of individual patient data should be performed.
Kidney disease in non-kidney solid organ transplantation.
Swanson K World J Transplant. 2022; 12(8):231-249.
PMID: 36159075 PMC: 9453292. DOI: 10.5500/wjt.v12.i8.231.
Induction Immunosuppression and Renal Outcomes in Adult Heart Transplantation.
Diaz-Castrillon C, Huckaby L, Hickey G, Sultan I, Kilic A J Surg Res. 2020; 259:14-23.
PMID: 33278793 PMC: 9015732. DOI: 10.1016/j.jss.2020.11.021.
Shiraishi Y, Amiya E, Hatano M, Katsuki T, Bujo C, Tsuji M ESC Heart Fail. 2020; 7(4):1842-1849.
PMID: 32445260 PMC: 7373882. DOI: 10.1002/ehf2.12749.
Complications of Cardiac Transplantation.
Potena L, Zuckermann A, Barberini F, Aliabadi-Zuckermann A Curr Cardiol Rep. 2018; 20(9):73.
PMID: 29992503 DOI: 10.1007/s11886-018-1018-3.
Helmschrott M, Rivinius R, Ruhparwar A, Schmack B, Erbel C, Gleissner C Drug Des Devel Ther. 2015; 9:1217-24.
PMID: 25759566 PMC: 4346008. DOI: 10.2147/DDDT.S79343.