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Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis

BACKGROUND: Nephrotoxicity of calcineurin inhibitors (CNIs) is the major concern for long-term allograft survival despite its predominant role in current immunosuppressive regime after renal transplantation. CNI nephrotoxicity is multifactorial with demographic, environmental, and pharmacogenetic fl...

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Autores principales: Xia, Tianyi, Zhu, Sang, Wen, Yan, Gao, Shouhong, Li, Mingming, Tao, Xia, Zhang, Feng, Chen, Wansheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836651/
https://www.ncbi.nlm.nih.gov/pubmed/29535503
http://dx.doi.org/10.2147/DDDT.S149340
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author Xia, Tianyi
Zhu, Sang
Wen, Yan
Gao, Shouhong
Li, Mingming
Tao, Xia
Zhang, Feng
Chen, Wansheng
author_facet Xia, Tianyi
Zhu, Sang
Wen, Yan
Gao, Shouhong
Li, Mingming
Tao, Xia
Zhang, Feng
Chen, Wansheng
author_sort Xia, Tianyi
collection PubMed
description BACKGROUND: Nephrotoxicity of calcineurin inhibitors (CNIs) is the major concern for long-term allograft survival despite its predominant role in current immunosuppressive regime after renal transplantation. CNI nephrotoxicity is multifactorial with demographic, environmental, and pharmacogenetic flexibility, whereas studies indicating risk factors for CNI nephrotoxicity obtained incomplete or conflicting results. METHODS: A systematic review and meta-analysis of risk factors for CNI nephrotoxicity was performed on all retrieved studies through a comprehensive research of network database. Data were analyzed by Review Manager 5.2 with heterogeneity assessed using the Cochrane Q and I(2) tests. CNI nephrotoxicity was primarily indicated with protocol biopsy or index-based clinical diagnosis, and the secondary outcome was defined as delayed graft function. RESULTS: Twelve observational studies containing a total of 2,849 cases were identified. Donor age (odds ratio [OR], 1.01; 95% CI, 1.01–1.03; p=0.02), recipient zero-time arteriosclerosis (OR, 1.44; 95% CI, 1.04–1.99; p=0.03), and CYP3A5*3/*3 genotype (OR, 2.80; 95% CI, 2.63–2.98; p=0.00) were confirmed as risk factors for CNI nephrotoxicity. Subgroup and sensitivity analysis claimed donor age as a significant contributor in Asian and Caucasian areas. CONCLUSION: Older donor age, recipient zero-time arteriosclerosis, and CYP3A5*3/*3 genotype might add up the risk for CNI nephrotoxicity, which could be interpreted into a robust biomarker system.
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spelling pubmed-58366512018-03-13 Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis Xia, Tianyi Zhu, Sang Wen, Yan Gao, Shouhong Li, Mingming Tao, Xia Zhang, Feng Chen, Wansheng Drug Des Devel Ther Review BACKGROUND: Nephrotoxicity of calcineurin inhibitors (CNIs) is the major concern for long-term allograft survival despite its predominant role in current immunosuppressive regime after renal transplantation. CNI nephrotoxicity is multifactorial with demographic, environmental, and pharmacogenetic flexibility, whereas studies indicating risk factors for CNI nephrotoxicity obtained incomplete or conflicting results. METHODS: A systematic review and meta-analysis of risk factors for CNI nephrotoxicity was performed on all retrieved studies through a comprehensive research of network database. Data were analyzed by Review Manager 5.2 with heterogeneity assessed using the Cochrane Q and I(2) tests. CNI nephrotoxicity was primarily indicated with protocol biopsy or index-based clinical diagnosis, and the secondary outcome was defined as delayed graft function. RESULTS: Twelve observational studies containing a total of 2,849 cases were identified. Donor age (odds ratio [OR], 1.01; 95% CI, 1.01–1.03; p=0.02), recipient zero-time arteriosclerosis (OR, 1.44; 95% CI, 1.04–1.99; p=0.03), and CYP3A5*3/*3 genotype (OR, 2.80; 95% CI, 2.63–2.98; p=0.00) were confirmed as risk factors for CNI nephrotoxicity. Subgroup and sensitivity analysis claimed donor age as a significant contributor in Asian and Caucasian areas. CONCLUSION: Older donor age, recipient zero-time arteriosclerosis, and CYP3A5*3/*3 genotype might add up the risk for CNI nephrotoxicity, which could be interpreted into a robust biomarker system. Dove Medical Press 2018-02-28 /pmc/articles/PMC5836651/ /pubmed/29535503 http://dx.doi.org/10.2147/DDDT.S149340 Text en © 2018 Xia et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Xia, Tianyi
Zhu, Sang
Wen, Yan
Gao, Shouhong
Li, Mingming
Tao, Xia
Zhang, Feng
Chen, Wansheng
Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
title Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
title_full Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
title_fullStr Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
title_full_unstemmed Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
title_short Risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
title_sort risk factors for calcineurin inhibitor nephrotoxicity after renal transplantation: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836651/
https://www.ncbi.nlm.nih.gov/pubmed/29535503
http://dx.doi.org/10.2147/DDDT.S149340
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