Tacrolimus versus cyclosporine for adult lung transplant recipients: a meta-analysis.

Abstract

BACKGROUND:

Tacrolimus and cyclosporine are the 2 major immunosuppressants for lung transplantation. Several studies have compared these 2 drugs, but the outcomes were not consistent. The aim of this meta-analysis of randomized controlled trials (RCTs) was to compare the beneficial and harmful effects of tacrolimus and cyclosporine as the primary immunosuppressant for lung transplant recipients.

METHODS:

We conducted searches of electronic databases and manual bibliographies. We performed a meta-analysis of all RCTs comparing tacrolimus with cyclosporine as primary immunosuppression for lung transplant recipients. Extracted, pooled data for mortality, acute rejection, withdrawals, and adverse events were analyzed using Mantel-Haenszel tests with a random effects model.

RESULTS:

Three RCTs including 297 patients were assessed in this study. Mortality at 1 year or more was comparable between lung recipients treated with tacrolimus and cyclosporine (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.42-2.10; P = .88). Tacrolimus-treated patients experienced fewer incidences of acute rejection (MD = -0.14; 95% CI, -0.28 to -0.01; P = .04). Pooled analysis showed a trend toward a lower risk of bronchiolitis obliterans syndrome (BOS) among tacrolimus-treated patients, although it did not reach significances (OR, 0.53; 95% CI, 0.25-1.12; P = .10). Fewer patients stopped tacrolimus than cyclosporine (OR, 0.12; 95% CI, 0.03-0.48; P = .003). The rate of new-onset diabetes was higher among the tacrolimus group (OR, 3.69; 95% CI, 1.17-11.62; P = .03). The incidence of hypertension and renal dysfunction were comparable in these 2 groups (OR, 0.24; 95% CI, 0.03-1.70; P = .15; and OR, 1.67; 95% CI, 0.70-3.96; P = .25, respectively). There was a trend toward lower risk of malignancy in tacrolimus-treated patients, although it did not reach significance either (OR, 0.19; 95% CI, 0.03-1.13; P = .07). The incidence of infection was comparable in these 2 groups (MD = -0.29, 95% CI, -0.68 to 0.11; P = .16).

CONCLUSION:

Using tacrolimus as primary immunosuppressant for lung transplant recipient resulted in comparable survival and reduction in acute rejection episodes when compared with cyclosporine.

• Authors: Y Fan, Y-B Xiao, Y-G Weng
• Journal: Transplantation proceedings (Transplant Proc) Vol. 41 Issue 5 Pg. 1821-4 (Jun 2009) ISSN: 1873-2623 [Electronic] United States
• PMID: 19545736 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Immunosuppressive Agents
• Cyclosporine
• Tacrolimus

Topics

• Adult
• Cyclosporine (therapeutic use)
• Graft Rejection (epidemiology, prevention & control)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Incidence
• Infections (epidemiology)
• Lung Transplantation (immunology, mortality)
• Odds Ratio
• Postoperative Complications (epidemiology)
• Randomized Controlled Trials as Topic
• Registries
• Survival Rate
• Tacrolimus (therapeutic use)
• Treatment Outcome