A Comparison Between Tacrolimus and Cyclosporine As Immunosuppression after Renal Transplantation in Children, A Meta-Analysis and Systematic Review

Authors

  • Yalda Ravanshad Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran Author
  • Anoush Azarfar Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Author
  • Sahar Ravanshad Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Author
  • Malihe Naderi Kalat Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran Author
  • Ali Ghasemi Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran Author
  • Mohaddeseh Golsorkhi Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran Author
  • Zahra Mostafavian Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran Author
  • Mohamad Esmaeeli Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran Author
  • Hassan Mehrad Majd Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran Author

Abstract

Introduction. There are some randomized trials which have already evaluated different calcineurin inhibitors (CNIs), especially comparing Tacrolimus and Cyclosporine, as immunosuppressant agents in children. However, their findings have been occasionally conflicting and thus debatable. Therefore, the evidence on safety and efficacy of immunosuppressive therapy after kidney transplantation in children has been inconclusive and argued to date. This study was aimed to compare the benefits and disadvantages of tacrolimus versus cyclosporine as the primary immunosuppression after renal transplantation in children. Methods. A systematic review and meta-analysis was done. An electronic literature review was conducted to identify appropriate studies. The outcomes were presented as relative risk, with 95% confidence intervals. Results. Five qualified randomized controlled trials were included in this systematic review. Tacrolimus was insignificantly superior to cyclosporine considering the total effect size of graft loss (RR = 0.67, 95% CI: 0.40 - 1.11; P > .05) and acute rejection (RR = 0.79, 95% CI: 0.59 – 1.05; P > .05). On the contrary, cyclosporine seemed to be insignificantly superior to tacrolimus regarding mortality rate (RR = 1.06, 95% CI: 0.59 - 1.90; P > .05). Conclusion. Admitting the study limitations mainly because of the nature and case study size of the included trials, it can be concluded from our systematic review results that Tacrolimus seems insignificantly superior to Cyclosporine respecting graft loss and acute rejection. However, Cyclosporine was shown to be insignificantly superior regarding mortality rate. However additional studies with a larger sample size are highly recommended.

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Published

2020-03-05

Issue

Section

ORIGINAL | Transplantation

How to Cite

A Comparison Between Tacrolimus and Cyclosporine As Immunosuppression after Renal Transplantation in Children, A Meta-Analysis and Systematic Review. (2020). Iranian Journal of Kidney Diseases, 14(2), 145-152. https://www.ijkd.org/index.php/ijkd/article/view/4812

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