Sirolimus and everolimus for primary immunosuppression in kidney transplant recipients

Sirolimus and everolimus appear to result in better renal function in the short-term, but more bone marrow suppression and lipid disturbances than calcineurin inhibitors (ciclosporin or tacrolimus).

A Cochrane review included 33 studies with a total of 7114 subjects. No differences in the hard-end points of patient and graft survival were demonstrated for or against TOR-I in any comparison. Generally surrogate endpoints for graft survival favour TOR-I (lower risk of acute rejection and higher GFR, mean difference compared to calcineurin inhibitors 14.94 mL/min, 95% CI 9.33 to 20.55) and surrogate endpoints for patient outcomes are worsened by TOR-I (bone marrow suppression, lipid disturbance).

Comment: Data were limited beyond two years post-transplantation. The quality of evidence is downgraded by indirectness (the use of surrogate endpoints).

Ədəbiyyat

1. Webster AC, Lee VW, Chapman JR, Craig JC. Target of rapamycin inhibitors (TOR-I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients. Cochrane Database Syst Rev 2006 Apr 19;(2):CD004290.