Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials
Main Author: | |
---|---|
Publication Date: | 2021 |
Other Authors: | , , , , , , , , , , |
Format: | Article |
Language: | eng |
Source: | Clinics |
Download full: | https://www.revistas.usp.br/clinics/article/view/192066 |
Summary: | A combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p =0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen. |
id |
USP-19_567f69401cc3b2a07e0cd4836fe46cca |
---|---|
oai_identifier_str |
oai:revistas.usp.br:article/192066 |
network_acronym_str |
USP-19 |
network_name_str |
Clinics |
repository_id_str |
|
spelling |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trialsMycophenolic AcidTacrolimusTransplantationImmunosuppressive AgentsA combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p =0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen.Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2021-11-09info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/clinics/article/view/19206610.6061/clinics/2021/e2597Clinics; v. 76 (2021); e2597Clinics; Vol. 76 (2021); e2597Clinics; Vol. 76 (2021); e25971980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/192066/176984Copyright (c) 2021 Clinicsinfo:eu-repo/semantics/openAccessTustumi, Francisco Miranda Neto, Antônio Afonso de Silveira Júnior, Sérgio Fernandes, Felipe Alexandre Silva, Miller Barreto de Brito e Ernani, Lucas Nacif, Lucas Souto Coelho, Fabricio Ferreira Andraus, Wellington Bernardo, Wanderley Marques Herman, Paulo Carneiro-D’Albuquerque, Luiz Augusto 2021-11-09T14:37:35Zoai:revistas.usp.br:article/192066Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2021-11-09T14:37:35Clinics - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
title |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
spellingShingle |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials Tustumi, Francisco Mycophenolic Acid Tacrolimus Transplantation Immunosuppressive Agents |
title_short |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
title_full |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
title_fullStr |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
title_full_unstemmed |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
title_sort |
Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and metaanalysis of randomized controlled trials |
author |
Tustumi, Francisco |
author_facet |
Tustumi, Francisco Miranda Neto, Antônio Afonso de Silveira Júnior, Sérgio Fernandes, Felipe Alexandre Silva, Miller Barreto de Brito e Ernani, Lucas Nacif, Lucas Souto Coelho, Fabricio Ferreira Andraus, Wellington Bernardo, Wanderley Marques Herman, Paulo Carneiro-D’Albuquerque, Luiz Augusto |
author_role |
author |
author2 |
Miranda Neto, Antônio Afonso de Silveira Júnior, Sérgio Fernandes, Felipe Alexandre Silva, Miller Barreto de Brito e Ernani, Lucas Nacif, Lucas Souto Coelho, Fabricio Ferreira Andraus, Wellington Bernardo, Wanderley Marques Herman, Paulo Carneiro-D’Albuquerque, Luiz Augusto |
author2_role |
author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Tustumi, Francisco Miranda Neto, Antônio Afonso de Silveira Júnior, Sérgio Fernandes, Felipe Alexandre Silva, Miller Barreto de Brito e Ernani, Lucas Nacif, Lucas Souto Coelho, Fabricio Ferreira Andraus, Wellington Bernardo, Wanderley Marques Herman, Paulo Carneiro-D’Albuquerque, Luiz Augusto |
dc.subject.por.fl_str_mv |
Mycophenolic Acid Tacrolimus Transplantation Immunosuppressive Agents |
topic |
Mycophenolic Acid Tacrolimus Transplantation Immunosuppressive Agents |
description |
A combination of immunosuppressants may improve outcomes due to the synergistic effect of their different action mechanisms. Currently, there is no consensus regarding the best immunosuppressive protocol after liver transplantation. This review aimed to evaluate the effectiveness and safety of tacrolimus associated with mycophenolate mofetil (MMF) in patients undergoing liver transplantation. We performed a systematic review and meta-analysis of randomized clinical trials. Eight randomized trials were included. The proportion of patients with at least one adverse event related to the immunosuppression scheme with tacrolimus associated with MMF was 39.9%. The tacrolimus with MMF immunosuppression regimen was superior in preventing acute cellular rejection compared with that of tacrolimus alone (risk difference [RD]=-0.11; p =0.001). The tacrolimus plus MMF regimen showed no difference in the risk of adverse events compared to that of tacrolimus alone (RD=0.7; p=0.66) and cyclosporine plus MMF (RD=-0.7; p=0.37). Patients undergoing liver transplantation who received tacrolimus plus MMF had similar adverse events when compared to patients receiving other evaluated immunosuppressive regimens and had a lower risk of acute rejection than those receiving in the monodrug tacrolimus regimen. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-11-09 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/192066 10.6061/clinics/2021/e2597 |
url |
https://www.revistas.usp.br/clinics/article/view/192066 |
identifier_str_mv |
10.6061/clinics/2021/e2597 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/192066/176984 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Clinics info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Clinics |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
dc.source.none.fl_str_mv |
Clinics; v. 76 (2021); e2597 Clinics; Vol. 76 (2021); e2597 Clinics; Vol. 76 (2021); e2597 1980-5322 1807-5932 reponame:Clinics instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Clinics |
collection |
Clinics |
repository.name.fl_str_mv |
Clinics - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
||clinics@hc.fm.usp.br |
_version_ |
1787713182443241472 |