他克莫司与环孢素A比较治疗胰肾联合移植术后排斥反应的Meta分析_《中国循证医学杂志》

作者：

吴斌 , 卢静 , 李健 , 柳汝明 ,  唐尧

四川大学华西医院药剂科（成都 610041）;

关键词：

胰肾联合移植免疫抑制他克莫司环孢素 Meta 分析

DOI：

10.7507/1672-2531.20090218

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　评价他克莫司（TAC）与环孢素A（CSA）治疗胰肾联合移植（SPKT）术后排斥反应的疗效和安全性。
方法　检索Cochrane 图书馆、MEDLINE、EMbase、SCI、CBM 数据库（检索时间从建库至2009 年3 月），纳入比较TAC 与CSA 治疗SPKT 术后排斥反应的随机对照试验（RCT），采用Cochrane 协作网推荐的方法进行质量评价和Meta 分析。
结果　共纳入5 个RCT，合计342 例患者。Meta 分析结果显示：TAC 组胰腺存活率高于CSA组［RR=1.15，95%CI（1.04，1.27）］；［RD=0.11，95%CI（0.03，0.19）］，但两组急性排斥反应、病人存活率、肾脏存活率及感染情况差异无统计学意义，其RR（95%CI）分别为0.81（0.58，1.12）、1.00（0.94，1.05）、1.02（0.95，1.09）和1.00（0.83，1.20）。
结论　基于当前证据，TAC 与CSA 比较治疗SPKT 术后排斥反应能提高胰腺存活率。治疗100例SPKT 患者，TAC 比CSA 多让11 例患者的胰腺存活。

引用本文： 吴斌,卢静,李健,柳汝明,唐尧. 他克莫司与环孢素A比较治疗胰肾联合移植术后排斥反应的Meta分析. 中国循证医学杂志, 2009, 09(11): 1214-1219. doi: 10.7507/1672-2531.20090218 复制

1.	Kelly WD, Lillehei RC, Merkel FK, et al. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery, 1967, 61(6): 827-837.
2.	Knoll GA, Nichol G. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options. J Am Soc Nephrol, 2003, 14(2): 500-515.
3.	Arbogast H, Malaise J, Illner WD, et al. Rejection after simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii11-17.
4.	Singh RP, Stratta RJ. Advances in immunosuppression for pancreas transplantation. Curr Opin Organ Transplant, 2008, 13(1): 79-84.
5.	Sutherland DE, Gores PF, Farney AC, et al. Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota. Am J Surg, 1993, 166(5): 456-491.
6.	Richter A, Davies DE, Alexander P. Growth inhibitory effects of FK506 and cyclosporin A independent of inhibition of calcineurin. Biochem Pharmacol, 1995, 49(3): 367-373.
7.	Boggi U, Vistoli F, Del Chiaro M, et al. Single-center, open, prospective, randomized pilot study comparing cyclosporine versus tacrolimus in simultaneous pancreas-kidney transplantation. Transplant Proc, 2004, 36(4): 1064-1066.
8.	Boggi U, Vistoli F, Del Chiaro M, et al. Neoral versus Prograf in simultaneous pancreas-kidney transplantation with portal venous drainage: Three-year results of a single-center, open-label, prospective, randomized pilot study. Transplant Proc, 2005, 37(6): 2641-2643.
9.	Bechstein WO, Malaise J, Saudek F, et al. Efficacy and safety of tacrolimus compared with cyclosporine microemulsion in primary simultaneous pancreas-kidney transplantation: 1-year results of a large multicenter trial. Transplantation, 2004, 77(8): 1221-1228.
10.	Saudek F, Malaise J, Boucek P, et al. Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in primary SPK transplantation: 3-year results of the Euro-SPK 001 trial. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii3-10.
11.	Woeste G, Wullstein C, Dette K, et al. Tacrolimus/mycophenolate mofetil vs cyclosporine A/Azathioprine after simultaneous pancreas and kidney transplantation: Five-year results of a randomized study. Transplant Proc, 2002, 34(5): 1920-1921.
12.	Schulz T, Konzack J , Büsing M. Mycophenolate mofet i l / prednisolone/single-shot ATG with tacrolimus or cyclosporine in pancreas/kidney transplantation: first results of an ongoing prospective randomized trial. Transplant Proc, 1999, 31(1-2): 591-592.
13.	Stegall MD, Simon M, Wachs ME, et al. Mycophenolate mofetil decreases rejection in simultaneous pancreas-kidney transplantation when combined with tacrolimus or cyclosporine. Transplantation, 1997, 64(12): 1695-1700.
14.	Schmied BM, Müller SA, Mehrabi A, et al. Immunosuppressive standards in simultaneous kidney-pancreas transplantation. Clin Transplant, 2006, 20(Suppl 17): 44-50.
15.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available at: www.cochranehandbook. org.
16.	Cochrane W. The combination of estimates from different experiments. Biometrics, 1954, 10(1): 101-129.
17.	Ye F, Ying-Bin X, Yu-Guo W, et al. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis. J Heart Lung Transplant, 2009, 28(1): 58-66.
18.	McAl i s ter VC, Haddad E, Renouf E, e t al . Cyclospor i n versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis. Am J Transplant, 2006, 6(7): 1578-1585.
19.	Webster AC, Woodroffe RC, Taylor RS, et al. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ, 2005, 331(7520): 810.
20.	Drachenberg CB, Klassen DK, Weir MR, et al. Islet cell damage associated with tacrolimus and cyclosporine: morphological features in pancreas allograft biopsies and clinical correlation. Transplantation, 1999, 68(3): 396-402.
21.	Delis S, Dervenis C, Bramis J, et al. Vascular complications of pancreas transplantation. Pancreas, 2004, 28(24): 413-420.
22.	Steurer W, Malaise J, Mark W, et al. Spectrum of surgical complications after simultaneous pancreas-kidney transplantation in a prospectively randomized study of two immunosuppressive protocols. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii54-62.

1. Kelly WD, Lillehei RC, Merkel FK, et al. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery, 1967, 61(6): 827-837.
2. Knoll GA, Nichol G. Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options. J Am Soc Nephrol, 2003, 14(2): 500-515.
3. Arbogast H, Malaise J, Illner WD, et al. Rejection after simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii11-17.
4. Singh RP, Stratta RJ. Advances in immunosuppression for pancreas transplantation. Curr Opin Organ Transplant, 2008, 13(1): 79-84.
5. Sutherland DE, Gores PF, Farney AC, et al. Evolution of kidney, pancreas, and islet transplantation for patients with diabetes at the University of Minnesota. Am J Surg, 1993, 166(5): 456-491.
6. Richter A, Davies DE, Alexander P. Growth inhibitory effects of FK506 and cyclosporin A independent of inhibition of calcineurin. Biochem Pharmacol, 1995, 49(3): 367-373.
7. Boggi U, Vistoli F, Del Chiaro M, et al. Single-center, open, prospective, randomized pilot study comparing cyclosporine versus tacrolimus in simultaneous pancreas-kidney transplantation. Transplant Proc, 2004, 36(4): 1064-1066.
8. Boggi U, Vistoli F, Del Chiaro M, et al. Neoral versus Prograf in simultaneous pancreas-kidney transplantation with portal venous drainage: Three-year results of a single-center, open-label, prospective, randomized pilot study. Transplant Proc, 2005, 37(6): 2641-2643.
9. Bechstein WO, Malaise J, Saudek F, et al. Efficacy and safety of tacrolimus compared with cyclosporine microemulsion in primary simultaneous pancreas-kidney transplantation: 1-year results of a large multicenter trial. Transplantation, 2004, 77(8): 1221-1228.
10. Saudek F, Malaise J, Boucek P, et al. Efficacy and safety of tacrolimus compared with cyclosporin microemulsion in primary SPK transplantation: 3-year results of the Euro-SPK 001 trial. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii3-10.
11. Woeste G, Wullstein C, Dette K, et al. Tacrolimus/mycophenolate mofetil vs cyclosporine A/Azathioprine after simultaneous pancreas and kidney transplantation: Five-year results of a randomized study. Transplant Proc, 2002, 34(5): 1920-1921.
12. Schulz T, Konzack J , Büsing M. Mycophenolate mofet i l / prednisolone/single-shot ATG with tacrolimus or cyclosporine in pancreas/kidney transplantation: first results of an ongoing prospective randomized trial. Transplant Proc, 1999, 31(1-2): 591-592.
13. Stegall MD, Simon M, Wachs ME, et al. Mycophenolate mofetil decreases rejection in simultaneous pancreas-kidney transplantation when combined with tacrolimus or cyclosporine. Transplantation, 1997, 64(12): 1695-1700.
14. Schmied BM, Müller SA, Mehrabi A, et al. Immunosuppressive standards in simultaneous kidney-pancreas transplantation. Clin Transplant, 2006, 20(Suppl 17): 44-50.
15. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available at: www.cochranehandbook. org.
16. Cochrane W. The combination of estimates from different experiments. Biometrics, 1954, 10(1): 101-129.
17. Ye F, Ying-Bin X, Yu-Guo W, et al. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis. J Heart Lung Transplant, 2009, 28(1): 58-66.
18. McAl i s ter VC, Haddad E, Renouf E, e t al . Cyclospor i n versus tacrolimus as primary immunosuppressant after liver transplantation: a meta-analysis. Am J Transplant, 2006, 6(7): 1578-1585.
19. Webster AC, Woodroffe RC, Taylor RS, et al. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ, 2005, 331(7520): 810.
20. Drachenberg CB, Klassen DK, Weir MR, et al. Islet cell damage associated with tacrolimus and cyclosporine: morphological features in pancreas allograft biopsies and clinical correlation. Transplantation, 1999, 68(3): 396-402.
21. Delis S, Dervenis C, Bramis J, et al. Vascular complications of pancreas transplantation. Pancreas, 2004, 28(24): 413-420.
22. Steurer W, Malaise J, Mark W, et al. Spectrum of surgical complications after simultaneous pancreas-kidney transplantation in a prospectively randomized study of two immunosuppressive protocols. Nephrol Dial Transplant, 2005, 20(Suppl 2): ii54-62.

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他克莫司与环孢素A比较治疗胰肾联合移植术后排斥反应的Meta分析

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