Everolimus in de novo liver transplant recipients: a systematic review

作     者：Cheng-Yong Tang Ai Shen Xu-Fu Wei Qing-Dong Li Rui Liu He-Jun Deng Yong-Zhong Wu Zhong-Jun Wu 

作者机构：Department of Pharmacy First Affiliated Hospital of Chongqing Medical University Department of Hepatobiliary Surgery Chongqing Cancer Institute Department of Hepatobiliary SurgeryFirst Affiliated Hospital of Chongqing Medical University Department of Radiotherapy Chongqing Cancer Institute 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2015年第14卷第5期

页      面：461-469页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：supported by grants from the National Nature Science Foundation of China(81171562) the Chongqing Medical Research Project(2011-2-081) the Frontier and Applied Basic Research Project of Chongqing(cstc2013yykf A0093) the Science and Technology Talent Cultivation Project of Chongqing(Young Talents of New Product Innovation)(cstc2013kjrcqnrc10006) 

主　　题：everolimus calcineurin inhibitors liver transplantation systematic review 

摘      要：BACKGROUND： Everolimus has no nephrotoxicity and is used to treat patients with post-liver transplant chronic renal insufficiency. The present systematic review was to evaluate the efficacy and safety of everolimus in de novo liver transplant *** SOURCES： Randomized controlled trials comparing everolimus for de novo liver transplant in Pub Med, the Cochrane Library, and Science Direct published up to March 31, 2014 were searched by two independent reviewers. Mean differences and 95% confidence interval（95% CI） for renal function, relative risk（RR） and 95% CI for treated biopsy-proven acute rejection（t BPAR）, graft loss, death, neoplasms/tumor recurrence, and adverse events were collected. Meta-analyses were performed with Rev Man version ***： A total of four randomized controlled trials covering 1119 cases were included. The meta-analyses revealed that compared with standard exposure of calcineurin inhibitors（CNIs）, everolimus combined with reduced CNIs improved creatinine clearance（calculated with the Cockcroft-Gault formula） by 5.13 m L/min at one year（95% CI： 0.42-9.84; P=0.03）, and decreased t BPAR（RR： 0.56; 95% CI： 0.35-0.90; P=0.02）. Everolimus initiation with CNIs elimination improved glomerular filtration rate（GFR, measured with the modification of diet in renal disease formula） of 10.42 m L/min/1.73 m2（95% CI： 3.44-17.41; P〈0.01） one year after treatment, but in-creased t BPAR（RR： 1.71; 95% CI： 1.15-2.53; P〈0.01）. Everolimus decreased the risk of neoplasms/tumor recurrence after liver transplant（RR： 0.60; 95% CI： 0.34-1.03; P=0.06）, but was associated with greater risk of adverse events which resulted in drug discontinuation（RR： 1.98; 95% CI： 1.49-2.64; P〈0.01）. CONCLUSIONS： Early introduction of everolimus combined with low-dose or no CNI in de novo liver transplant significantly improves renal function one year post treatment. Everolimus combined with low-dose CNI decreases the risk of t BPAR one year after liver transplant, but everoli