A meta-analysis of immunosuppression withdrawal trials in renal transplantation
A meta-analysis of immunosuppression withdrawal trials in renal transplantation
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DOI：
10.1681/asn.v11101910
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发表时间：
2000-10-01
影响因子：
13.6
通讯作者：
Ma, JZ
中科院分区：
文献类型：
--
作者：
Kasiske, BL;Chakkera, HA;Ma, JZ
自从之前发表的关于肾移植受者环孢素 (CsA) 和泼尼松戒断的荟萃分析以来，已经报道了几项额外的、随访时间更长的随机对照试验。目前，在9项泼尼松停药试验中（n=1461），出现急性排斥反应的患者比例增加了0.14（95%置信区间=0.10至0.17，P<0.001）。在九项泼尼松戒断试验（n = 1899）中，戒断后移植失败的相对风险（RR；RR = 1.0表示无风险）也增加（RR = 1.40；范围1.09至1.70，P = 0.012）。在泼尼松停药试验中，通过 chi(2) 检验，没有证据表明急性排斥或移植失败存在研究间异质性（P > 0.05）。在 10 项 CsA 停药试验中（n = 1049），出现急性排斥反应的患者比例增加了 0.11（0.07 至 0.15，P < 0.001）。在 12 项试验（n = 1151）中，CsA 撤药后移植失败的 RR 为 1.06（95% 置信区间，0.82 至 1.29，P = 0.646），但 chi(2) 检验表明存在研究异质性。然而，在随访时间至少为 4.0 年（5.8 +/- 1.7）的六项研究（n = 632）中（RR = 0.92；范围，0.64 至 1.20，P = 0.569）或在同行评审期刊上发表的七项试验（n = 962）中（RR = 0.95；范围，0.70 至 0.70），没有证据表明存在异质性。 1.30，P = 0.682）。最后，在比较 CsA 和泼尼松停药的三项试验 (n = 259) 中，CsA 停药后移植失败较少，但没有显着趋势（RR = 0.63；范围，0.08 至 1.16，P = 0.190）。因此，与泼尼松停药不同，部分患者停药 CsA 似乎不会带来长期移植失败的风险。
Since the publication of previous meta-analyses of cyclosporine (CsA) and prednisone withdrawal in renal transplant recipients, several additional randomized controlled trials with longer follow-up have been reported. Currently, in nine prednisone withdrawal trials (n = 1461), the proportion of patients with acute rejection was increased by 0.14 (95% confidence interval = 0.10 to 0.17, P < 0.001). In nine prednisone withdrawal trials (n = 1899), the relative risk (RR; RR = 1.0 indicates no risk) of graft failure after withdrawal was also increased (RR = 1.40; range, 1.09 to 1.70, P = 0.012). There was no evidence of between-study heterogeneity for either acute rejection or graft failure in the prednisone withdrawal trials by a chi(2) test (P > 0.05). In 10 CsA withdrawal trials (n = 1049), the proportion of patients with acute rejection was increased by 0.11 (0.07 to 0.15, P < 0.001). In 12 trials (n = 1151), the RR of graft failure after CsA withdrawal was 1.06 (95% confidence interval, 0.82 to 1.29, P = 0.646), but a chi(2) test indicated that there was study heterogeneity. However, there was no evidence of heterogeneity in the six studies (n = 632) with at least 4.0 yr (5.8 +/- 1.7) of follow-up (RR = 0.92; range, 0.64 to 1.20, P = 0.569) or in the seven trials (n = 962) published in peer-reviewed journals (RR = 0.95; range, 0.70 to 1.30, P = 0.682). Finally, in three trials (n = 259) that compared CsA and prednisone withdrawal, there was a nonsignificant trend for less graft failure with CsA withdrawal (RR = 0.63; range, 0.08 to 1.16, P = 0.190). Thus, unlike prednisone withdrawal, CsA withdrawal in select patients seems to impart little risk of long-term graft failure.