Tacrolimus versus cyclosporine immunosuppression in lung transplantation: a systematic review and meta-analysis.

IF 3.6 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2025-04-10 DOI:10.1136/bmjresp-2024-002672

Tyler Pitre, Samuel Gurupatham, Kairavi Desai, Matthew Binnie, Tereza Martinu, Stephen Juvet, Dena Zeraatkar

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引用次数: 0

Abstract

Background: The relative efficacy of calcineurin inhibitors tacrolimus and cyclosporine in lung transplantation remains unclear. To clarify, we conducted a systematic review and meta-analysis.

Methods: We searched through EMBASE, MEDLINE and Cochrane CENTRAL until 23 October 2023 for randomised trials comparing tacrolimus with cyclosporine in lung transplant recipients. Data extraction and bias risk assessment were done independently. Analyses included random effects pairwise meta-analysis and trial sequential analysis, with GRADE system for evidence certainty.

Results: We found four eligible trials totalling 662 patients. Tacrolimus significantly reduces the risk of chronic lung allograft dysfunction (RR 0.46, high certainty) and likely decreases acute rejection risk (RR 0.83, moderate certainty), with no clear difference in mortality (RR 1.08, low certainty). It may raise new-onset diabetes mellitus (RR 4.17, low certainty) and renal dysfunction risks (RR 1.27, low certainty).

Conclusion: Tacrolimus likely lowers acute rejection and chronic dysfunction risks in lung transplant recipients without improving survival rates. However, it might increase the chances of developing diabetes mellitus and renal dysfunction. These findings guide the choice between tacrolimus and cyclosporine, balancing benefits against potential risks.

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他克莫司与环孢素在肺移植中的免疫抑制：一项系统综述和荟萃分析。

背景：钙调磷酸酶抑制剂他克莫司和环孢素在肺移植中的相对疗效尚不清楚。为了澄清，我们进行了系统回顾和荟萃分析。方法：我们检索了EMBASE、MEDLINE和Cochrane CENTRAL，直到2023年10月23日，在肺移植受者中比较他克莫司和环孢素的随机试验。数据提取和偏倚风险评估独立完成。分析包括随机效应两两荟萃分析和试验序列分析，证据确定性采用GRADE系统。结果：我们找到了4个符合条件的试验，共计662例患者。他克莫司显著降低同种异体肺移植慢性功能障碍的风险（RR 0.46，高确定性），并可能降低急性排斥风险（RR 0.83，中等确定性），死亡率无明显差异（RR 1.08，低确定性）。可能增加新发糖尿病（RR 4.17，低确定性）和肾功能障碍风险（RR 1.27，低确定性）。结论：他克莫司可能降低肺移植受者的急性排斥反应和慢性功能障碍风险，但不提高生存率。然而，它可能会增加患糖尿病和肾功能障碍的机会。这些发现指导了他克莫司和环孢素之间的选择，平衡了益处和潜在风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.