PMID- 28107397
OWN - NLM
STAT- MEDLINE
DCOM- 20170810
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 1
DP  - 2017
TI  - Efficacy and Safety of Everolimus for Maintenance Immunosuppression of Kidney 
      Transplantation: A Meta-Analysis of Randomized Controlled Trials.
PG  - e0170246
LID - 10.1371/journal.pone.0170246 [doi]
LID - e0170246
AB  - BACKGROUND: Conversion to everolimus is often used in kidney transplantation to 
      overcome calcineurin inhibitor (CNI) nephrotoxicity but there is conflicting 
      evidence for this approach. OBJECTIVES: To investigate the benefits and harm from 
      randomized clinical trials (RCTs) involving the conversion from CNI to everolimus 
      after kidney transplantation. METHODS: Databases were searched up to March 2016. 
      Two reviewers independently assessed trials for eligibility and quality, and 
      extracted data. Results are expressed as risk ratio (RR) or mean difference (MD) 
      with 95% confidence intervals (CI). RESULTS: Eleven RCTs, with a total of 1,633 
      patients, met the final inclusion criteria. Patients converted to everolimus had 
      improved renal function at 1 year posttransplant with an estimated glomerular 
      filtration rate (eGFR) of 5.36 mL/min per 1.73 m2 greater than patients remaining 
      on CNI (p = 0.0005) and the longer-term results (> 1 year) of renal function was 
      identical to that of 1 year. There was not a substantial difference in graft 
      loss, mortality, and the occurrence of adverse events (AEs) or serious AEs. 
      However, the risks of acute rejection and trial termination due to AEs with 
      everolimus are respectively 1.82 and 2.63 times greater than patients staying on 
      CNI at 1 year posttransplant (p = 0.02, p = 0.03, respectively). Further, those 
      patients who converted to everolimus had a substantially greater risk of anemia, 
      hyperlipidemia, hypercholesterolemia, hypokalemia, proteinuria, stomatitis, mouth 
      ulceration, and acne. CONCLUSIONS: Conversion from CNI to everolimus after kidney 
      transplantation is associated with improved renal function in the first 5 years 
      posttransplant but increases the risk of acute rejection at 1 year posttransplant 
      and may not be well endured.
FAU - Liu, Jinyu
AU  - Liu J
AD  - Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, Hubei, China.
FAU - Liu, Dong
AU  - Liu D
AD  - Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, Hubei, China.
FAU - Li, Juan
AU  - Li J
AD  - Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, Hubei, China.
FAU - Zhu, Lan
AU  - Zhu L
AD  - Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, Hubei, China.
FAU - Zhang, Chengliang
AU  - Zhang C
AD  - Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, Hubei, China.
FAU - Lei, Kai
AU  - Lei K
AD  - Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, Hubei, China.
FAU - Xu, Qiling
AU  - Xu Q
AD  - Department of Biotechnology and Molecules, Assumption College, Worcester, 
      Massachusetts, United States of America.
FAU - You, Ruxu
AU  - You R
AD  - Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong 
      University of Science and Technology, Wuhan, Hubei, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20170120
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Immunosuppressive Agents)
RN  - 9HW64Q8G6G (Everolimus)
SB  - IM
MH  - Everolimus/*administration & dosage
MH  - Graft Rejection
MH  - Humans
MH  - Immunosuppressive Agents/*administration & dosage
MH  - Kidney Function Tests
MH  - *Kidney Transplantation
MH  - *Randomized Controlled Trials as Topic
PMC - PMC5249216
COIS- The authors have declared that no competing interests exist.
EDAT- 2017/01/21 06:00
MHDA- 2017/08/11 06:00
PMCR- 2017/01/20
CRDT- 2017/01/21 06:00
PHST- 2016/09/02 00:00 [received]
PHST- 2016/12/30 00:00 [accepted]
PHST- 2017/01/21 06:00 [entrez]
PHST- 2017/01/21 06:00 [pubmed]
PHST- 2017/08/11 06:00 [medline]
PHST- 2017/01/20 00:00 [pmc-release]
AID - PONE-D-16-35211 [pii]
AID - 10.1371/journal.pone.0170246 [doi]
PST - epublish
SO  - PLoS One. 2017 Jan 20;12(1):e0170246. doi: 10.1371/journal.pone.0170246. 
      eCollection 2017.