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dc.contributor.authorGlover, Thomas Een
dc.contributor.authorWatson, Christopheren
dc.contributor.authorGibbs, Paulen
dc.contributor.authorBradley, Johnen
dc.contributor.authorNtzani, Evangelia Een
dc.contributor.authorKosmoliaptsis, Vasilisen
dc.date.accessioned2015-09-24T09:38:21Z
dc.date.available2015-09-24T09:38:21Z
dc.date.issued2015-12-04en
dc.identifier.citationGlover et al. Transplantation (2015) Vol. 100 Issue 3, pp. 621–629. doi:10.1097/TP.0000000000001006en
dc.identifier.issn0041-1337
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/251136
dc.description.abstractContext: Conversion to mammalian target of rapamycin inhibitors (mTORi) is often utilised in liver transplantation to overcome calcineurin inhibitor (CNI) nephrotoxicity but the evidence base for this approach is not well defined. Objective: To summarise the evidence, from randomised-clinical-trials (RCTs), for conversion from CNI to mTORi-based immunosuppression after liver transplantation. Data Sources: Databases and conference abstracts were searched up to August 2015. Study Selection: RCTs evaluating conversion from CNI to mTORi-based maintenance immunosuppression following adult liver transplantation. Data Extraction: Descriptive and quantitative information was extracted; summary mean difference (MD) and risk ratio (RR) estimates were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and I2 . Data synthesis: Ten RCTs, with a total of 1,927 patients, met the final inclusion criteria. Patients converted to mTORi had significantly better renal function at 1 year following randomisation compared to patients remaining on CNI (MD: 7.48 mL/min/1.73m², 95%CI: 3.18-11.8). The risks of graft loss (RR: 0.77, 95%CI: 0.29-2.09, I²: 31%) and patient death (RR: 1.05, 95%CI: 0.63-1.73, I²: 0%) were similar for patients converted to mTORi and patients remaining on CNI. However, conversion to mTORi was associated with a higher risk of acute rejection (RR: 1.76, 95%CI: 1.33-2.34, I²: 0%) and study discontinuation due to adverse events (RR: 2.17, 95%CI: 1.38-3.44, I²: 63%) up to one year post-randomisation. Conclusions: Conversion from CNI to mTORi following liver transplantation is associated with improved renal function after one year but increases the risk of acute rejection and may be poorly tolerated.
dc.description.sponsorshipThe study was funded in part by the NIHR Cambridge Biomedical Research Centre.
dc.languageEnglishen
dc.language.isoenen
dc.publisherLippincott Williams & Wilkins
dc.titleConversion from calcineurin to mammalian target of rapamycin inhibitors in liver transplantation: a meta-analysis of randomised controlled trialsen
dc.typeArticle
dc.description.versionThis is the author accepted manuscript. The final version is available from Lippincott Williams & Wilkins via http://dx.doi.org/10.1097/TP.0000000000001006en
prism.endingPage629
prism.publicationDate2015en
prism.publicationNameTransplantationen
prism.startingPage621
prism.volume100en
dc.rioxxterms.funderNIHR
rioxxterms.versionofrecord10.1097/TP.0000000000001006en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2015-12-04en
dc.contributor.orcidWatson, Christopher [0000-0002-0590-4901]
dc.contributor.orcidKosmoliaptsis, Vasilis [0000-0001-7298-1387]
dc.identifier.eissn1534-6080
rioxxterms.typeJournal Article/Reviewen
rioxxterms.freetoread.startdate2016-12-04


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