Calcineurin-Inhibitor-Sparing Regimens Improve Outcomes

Use of calcineurin-inhibitor-sparing regimens immediately after kidney transplant ups outcomes

WEDNESDAY, Sept. 28 (HealthDay News) -- Use of calciuneurin-inhibitor-sparing regimens immediately after kidney transplantation is associated with improved outcomes, including less delayed graft function, improved graft function, and less new-onset diabetes, according to a meta-analysis published online Sept. 23 in the Journal of the American Society of Nephrology.

Adnan Sharif, M.D., from the Queen Elizabeth Hospital in Birmingham, U.K., and colleagues reviewed available literature to examine the outcomes associated with reducing calcineurin inhibitor exposure from the time of kidney transplantation. A total of 56 studies with data comparing de-novo calcineurin-inhibitor-sparing regimens with calcineurin-inhibitor-based regimens for 11,337 renal transplant recipients were analyzed.

The investigators found that the odds of overall graft failure were significantly decreased with the use of the contemporary agents belatacept or tofacitinib, in combination with mycophenolate (odds ratio [OR], 0.61). The odds of graft failure were also reduced with the minimization of calcineurin inhibitors in combination with induction and adjunctive agents (OR, 0.73). However, the odds of graft failure increased with the use of inhibitors of mammalian target of rapamycin in combination with mycophenolate (OR, 1.43). Use of calcineurin-inhibitor-sparing strategies correlated with less delayed graft function (OR, 0.89), less new-onset diabetes, and better graft function. There was no increase in the rates of acute rejection with more contemporary protocols.

"This meta-analysis suggests that reducing exposure to calcineurin inhibitors immediately after kidney transplantation may improve clinical outcomes," the authors write.

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