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Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials
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 tacro...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Faculdade de Medicina / USP
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920399/ https://www.ncbi.nlm.nih.gov/pubmed/33681947 http://dx.doi.org/10.6061/clinics/2021/e2597 |
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author | Tustumi, Francisco de Miranda, Antonio Afonso Silveira, 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_facet | Tustumi, Francisco de Miranda, Antonio Afonso Silveira, 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_sort | Tustumi, Francisco |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-7920399 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Faculdade de Medicina / USP |
record_format | MEDLINE/PubMed |
spelling | pubmed-79203992021-03-05 Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials Tustumi, Francisco de Miranda, Antonio Afonso Silveira, 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 Clinics (Sao Paulo) Review Article 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. Faculdade de Medicina / USP 2021-03-01 2021 /pmc/articles/PMC7920399/ /pubmed/33681947 http://dx.doi.org/10.6061/clinics/2021/e2597 Text en Copyright © 2021 CLINICS http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited. |
spellingShingle | Review Article Tustumi, Francisco de Miranda, Antonio Afonso Silveira, 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 Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
title | Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
title_full | Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
title_fullStr | Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
title_full_unstemmed | Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
title_short | Safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
title_sort | safety and effectiveness of mycophenolate mofetil associated with tacrolimus for liver transplantation immunosuppression: a systematic review and meta-analysis of randomized controlled trials |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920399/ https://www.ncbi.nlm.nih.gov/pubmed/33681947 http://dx.doi.org/10.6061/clinics/2021/e2597 |
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