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Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review

Immunosuppressive agents are used post-organ transplant to prevent acute rejection and graft losses. Tacrolimus, the most widely used immunosuppressive agent for kidney transplant recipients, has unfavorable side effects such as new-onset diabetes after transplant, nephrotoxicity, and electrolyte im...

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Autores principales: Qayyum, Shahid, Shahid, Kamran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512192/
https://www.ncbi.nlm.nih.gov/pubmed/37746361
http://dx.doi.org/10.7759/cureus.43903
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author Qayyum, Shahid
Shahid, Kamran
author_facet Qayyum, Shahid
Shahid, Kamran
author_sort Qayyum, Shahid
collection PubMed
description Immunosuppressive agents are used post-organ transplant to prevent acute rejection and graft losses. Tacrolimus, the most widely used immunosuppressive agent for kidney transplant recipients, has unfavorable side effects such as new-onset diabetes after transplant, nephrotoxicity, and electrolyte imbalances. Other drug groups such as the mammalian target of rapamycin (mTOR) inhibitors, belatacept, and bleselumab have been used to either substitute calcineurin inhibitors or reduce their exposure. This systematic analysis reviews evidence from randomized controlled trials to compare the safety and efficacy of various immunosuppressive regimens for kidney transplant recipients. An in-depth methodical search was conducted across PubMed, Cochrane Library, and Mendeley. PRISMA 2020 guidelines were followed for this study. Randomized controlled trials comparing varying regimens were included in this study. While there was no difference in safety and efficacy between once-daily and twice-daily tacrolimus, mTOR inhibitors showed to be a viable option for a reduced tacrolimus exposure regimen. Calcineurin inhibitor avoidance and early steroid withdrawal regimens both showed increased rates of rejection. Based on these findings, a regimen containing once-daily tacrolimus and an mTOR inhibitor with or without corticosteroid is a viable immunosuppressive regimen post-kidney transplant. Further trials, especially ones with longer follow-up periods, are needed to explore these regimens' long-term safety and efficacy.
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spelling pubmed-105121922023-09-22 Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review Qayyum, Shahid Shahid, Kamran Cureus Internal Medicine Immunosuppressive agents are used post-organ transplant to prevent acute rejection and graft losses. Tacrolimus, the most widely used immunosuppressive agent for kidney transplant recipients, has unfavorable side effects such as new-onset diabetes after transplant, nephrotoxicity, and electrolyte imbalances. Other drug groups such as the mammalian target of rapamycin (mTOR) inhibitors, belatacept, and bleselumab have been used to either substitute calcineurin inhibitors or reduce their exposure. This systematic analysis reviews evidence from randomized controlled trials to compare the safety and efficacy of various immunosuppressive regimens for kidney transplant recipients. An in-depth methodical search was conducted across PubMed, Cochrane Library, and Mendeley. PRISMA 2020 guidelines were followed for this study. Randomized controlled trials comparing varying regimens were included in this study. While there was no difference in safety and efficacy between once-daily and twice-daily tacrolimus, mTOR inhibitors showed to be a viable option for a reduced tacrolimus exposure regimen. Calcineurin inhibitor avoidance and early steroid withdrawal regimens both showed increased rates of rejection. Based on these findings, a regimen containing once-daily tacrolimus and an mTOR inhibitor with or without corticosteroid is a viable immunosuppressive regimen post-kidney transplant. Further trials, especially ones with longer follow-up periods, are needed to explore these regimens' long-term safety and efficacy. Cureus 2023-08-22 /pmc/articles/PMC10512192/ /pubmed/37746361 http://dx.doi.org/10.7759/cureus.43903 Text en Copyright © 2023, Qayyum et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Qayyum, Shahid
Shahid, Kamran
Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review
title Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review
title_full Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review
title_fullStr Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review
title_full_unstemmed Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review
title_short Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney Transplant: A Systematic Review
title_sort comparative safety and efficacy of immunosuppressive regimens post-kidney transplant: a systematic review
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10512192/
https://www.ncbi.nlm.nih.gov/pubmed/37746361
http://dx.doi.org/10.7759/cureus.43903
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