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Article
Cyclosporin versus Tacrolimus for Liver Transplanted Patients
Cochrane Database of Systematic Reviews
  • Elizabeth Haddad, University of Western Ontario
  • Vivian McAlister, University of Western Ontario
  • Elizabeth Renouf, University of Western Ontario
  • Richard Malthaner, University of Western Ontario
  • Mette S. Kjaer, Rigshospitalet, Copenhagen, Denmark
  • Lise Lotte Gluud, Copenhagen University Hospital, Copenhagen, Denmark
Document Type
Article
Publication Date
1-1-2006
URL with Digital Object Identifier
http://dx.doi.org/10.1002/14651858.CD005161.pub2
Abstract
A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring>tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73-0.99; graft loss: RR 0.73, 95% CI 0.61-0.86). Tacrolimus reduced the number of recipients with acute rejection (RR 0.81, 95% CI 0.75-0.88) and steroid-resistant rejection (RR 0.54, 95% CI 0.47-0.74) in the first year. Lymphoproliferative disorder or dialysis rates were not different but more de novo diabetes (RR 1.38, 95% CI 1.01-1.86) occurred with tacrolimus. More patients stopped cyclosporin than tacrolimus (RR 0.57, 95% CI 0.49-0.66). Treating 100 recipients with tacrolimus instead of cyclosporin would avoid rejection and steroid-resistant rejection in nine and seven patients respectively, graft loss and death in five and two patients respectively, but four additional patients would develop diabetes after liver transplantation.
Notes
This review is published as a Cochrane review in the Cochrane Database of Systematic Reviews 2006, Issue 4. Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.
Citation Information
Elizabeth Haddad, Vivian McAlister, Elizabeth Renouf, Richard Malthaner, et al.. "Cyclosporin versus Tacrolimus for Liver Transplanted Patients" Cochrane Database of Systematic Reviews Iss. 4 (2006) p. CD005161
Available at: http://works.bepress.com/richard_malthaner/22/