PMID- 37746361
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230926
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 8
DP  - 2023 Aug
TI  - Comparative Safety and Efficacy of Immunosuppressive Regimens Post-kidney 
      Transplant: A Systematic Review.
PG  - e43903
LID - 10.7759/cureus.43903 [doi]
LID - e43903
AB  - Immunosuppressive agents are used post-organ transplant to prevent acute 
      rejection and graft losses. Tacrolimus, the most widely used immunosuppressive 
      agent for kidney transplant recipients, has unfavorable side effects such as 
      new-onset diabetes after transplant, nephrotoxicity, and electrolyte imbalances. 
      Other drug groups such as the mammalian target of rapamycin (mTOR) inhibitors, 
      belatacept, and bleselumab have been used to either substitute calcineurin 
      inhibitors or reduce their exposure. This systematic analysis reviews evidence 
      from randomized controlled trials to compare the safety and efficacy of various 
      immunosuppressive regimens for kidney transplant recipients. An in-depth 
      methodical search was conducted across PubMed, Cochrane Library, and Mendeley. 
      PRISMA 2020 guidelines were followed for this study. Randomized controlled trials 
      comparing varying regimens were included in this study. While there was no 
      difference in safety and efficacy between once-daily and twice-daily tacrolimus, 
      mTOR inhibitors showed to be a viable option for a reduced tacrolimus exposure 
      regimen. Calcineurin inhibitor avoidance and early steroid withdrawal regimens 
      both showed increased rates of rejection. Based on these findings, a regimen 
      containing once-daily tacrolimus and an mTOR inhibitor with or without 
      corticosteroid is a viable immunosuppressive regimen post-kidney transplant. 
      Further trials, especially ones with longer follow-up periods, are needed to 
      explore these regimens' long-term safety and efficacy.
CI  - Copyright (c) 2023, Qayyum et al.
FAU - Qayyum, Shahid
AU  - Qayyum S
AD  - Nephrology, Diaverum Dialysis Center, Wadi Al Dawasir, SAU.
FAU - Shahid, Kamran
AU  - Shahid K
AD  - Internal Medicine/Family Medicine, California Institute of Behavioral 
      Neurosciences & Psychology, Fairfield, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230822
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10512192
OTO - NOTNLM
OT  - belatacept
OT  - bleselumab
OT  - calcineurin inhibitors
OT  - everolimus
OT  - graft rejection
OT  - immunosuppression
OT  - kidney transplantation
OT  - sirolimus
OT  - transplant nephrology
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/09/25 06:43
MHDA- 2023/09/25 06:44
PMCR- 2023/08/22
CRDT- 2023/09/25 05:15
PHST- 2023/08/22 00:00 [accepted]
PHST- 2023/09/25 06:44 [medline]
PHST- 2023/09/25 06:43 [pubmed]
PHST- 2023/09/25 05:15 [entrez]
PHST- 2023/08/22 00:00 [pmc-release]
AID - 10.7759/cureus.43903 [doi]
PST - epublish
SO  - Cureus. 2023 Aug 22;15(8):e43903. doi: 10.7759/cureus.43903. eCollection 2023 
      Aug.