Korean J Transplant.  2022 Nov;36(Supple 1):S89. 10.4285/ATW2022.F-2050.

A systematic review and meta-analysis comparing everolimus+CNI with MMF+CNI in kidney transplant

• Rejante LV
• Tanhui K
• Alolod MK

• KMID: 2535605
• DOI: http://doi.org/10.4285/ATW2022.F-2050

Abstract

Background
The ideal immunosuppression for kidney transplant patients has the least incidence of acute rejection with the least occurrence of adverse events. This study aims to compare the everolimus against mycophenolate mofetil/sodium in combination with calcineurin inhibitors (CNI) with or without steroids as maintenance immunosuppression in kidney transplant patients.
Methods
Studies, databases and literature were searched in Pubmed, the Cochrane Central Register of Controlled Trials and grey literature to identify relevant studies until August 21, 2022. Assessment of risk of bias was done independently by two au- thors using the revised Cochrane risk of bias assessment tool (RoB 2). Rev-man 5.4 program was used to calculate the risk ratio with corresponding 95% confidence interval for biopsy-proven acute rejection, death and infection. Mean difference was used to compare estimated glomerular filtration rate between two groups.
Results
Sixteen RCTs with a total of 5,403 patients comparing everolimus (n=2,763) with MMF (n=2,542) in maintenance immu-nosuppression post kidney transplant were retrieved and synthesized in the meta-analysis. Results of the study showed no sig-nificant difference in the risk for biopsy-proven acute rejection (risk ratio [RR], 1.12; 95% confidence interval [CI], 0.92–1.35; P= 0.13; I2=29%) and death (RR, 0.85; 95% CI, 0.63–1.16; P= 0.57; I2=0%). There is no significant mean difference of the eGFR between two groups (mean deviation [MD], 0.93; 95% CI, –2.25–4.1; P<0.00001; I2= 84%). There was significant increased risks for any infec-tion in the MMF group compared with the everolimus group (RR, 0.83; 95% CI, 0.73–0.93; P=0.0003; I2=66%).
Conclusions
This meta-analysis showed that everolimus and MMF combined with CNI (cyclosporine or tacrolimus) have no difference in the risks for biopsy-proven acute rejection, death and increased in estimated GFR However, the MMF group exhibited a significant increased risks for any infection. They are equally safe and effective for kidney transplantation recipients.