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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 24, 2017; 7(2): 144-151
Published online Apr 24, 2017. doi: 10.5500/wjt.v7.i2.144
Systemic meta-analysis assessing the short term applicability of early conversion to mammalian target of rapamycin inhibitors in kidney transplant
Jayant Kumar, Isabella Reccia, Tomokazu Kusano, Bridson M Julie, Ajay Sharma, Ahmed Halawa
Jayant Kumar, Isabella Reccia, Tomokazu Kusano, Department of Cancer and Surgery, Imperial College, London W120HS, United Kingdom
Bridson M Julie, Ajay Sharma, Ahmed Halawa, Faculty of Health and Sciences, Institute of Learning and Teaching, University of Liverpool, Liverpool L693BX, United Kingdom
Ajay Sharma, Department of Surgery, Royal Liverpool University Hospital, Liverpool L78XP, United Kingdom
Ahmed Halawa, Department of Surgery, Sheffield Teaching Hospitals, Sheffield S102JF, United Kingdom
Author contributions: Kumar J and Halawa A designed study; Kumar J and Reccia I collected data; Kumar J, Reccia I, Kusano T and Julie BM analyzed data; Kumar J, Sharma A and Halawa A wrote paper.
Conflict-of-interest statement: None of the contributing authors have any conflict of interest, including specific financial interests or relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.
Data sharing statement: The manuscript summarizes data as have been reported in published literature to date. There were no new patients studied, and no new data compiled. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jayant Kumar, MD, MS, Department of Cancer and Surgery, Imperial College, Du Cane Road, London W120HS, United Kingdom. jkumar@ic.ac.uk
Telephone: +44-74-59934454
Received: November 22, 2016
Peer-review started: November 24, 2016
First decision: January 16, 2017
Revised: February 6, 2017
Accepted: February 28, 2017
Article in press: March 2, 2017
Published online: April 24, 2017
AIM
To consolidate the present evidence of effectiveness in renal functioning and graft survival following early introduction of mammalian target of rapamycin (mTOR) inhibitors with or without calcineurin inhibitors (CNIs) in renal transplant recipients.
METHODS
We analysed the current literature following PROSPERO approval describing the role of immunosuppressive agent, mTOR inhibitors as an alternative to CNI within six months of renal transplant by searching the PubMed, EMBASE, Cochrane, Crossref, and Scopus using MeSH terms.
RESULTS
Six articles of early withdrawal of CNI and introduction of mTOR-inhibitors within six months of renal transplantation were sought. Glomerular filtration rate (GFR) and serum creatinine were significantly better in mTOR inhibitor group with equivalent survival at 12 mo, even though Biopsy Proven Acute rejection was significantly higher in mTOR-inhibitor group.
CONCLUSION
The evidence reviewed in this meta-analysis suggests that early introduction mTOR-inhibitors substantial CNI minimization. The mTOR inhibitors such as everolimus and sirolimus, due to their complementary mechanism of action and favourable nephrotoxicity profile; better glomerular filtration, lower serum creatinine with equivalent survival. Having said that, due to the higher rejection rate, may influence the use of these regimens to patients with moderate to high immunological risk patients.
Core tip: Early calcineurin inhibitor withdrawal seems to be more pragmatic approach as it bestows better renal functioning in the low immunological risk renal transplant recipients.
