Risk of metabolic complications in kidney transplantation after conversion to mTOR inhibitor: a systematic review and...

Area of Science:

• Nephrology
• Immunosuppression
• Transplantation

Background:

• Calcineurin inhibitors (CNI) are standard post-kidney transplant but cause nephrotoxicity.
• Mammalian target of rapamycin (mTOR) inhibitors are an alternative to reduce CNI-induced nephrotoxicity.
• mTOR inhibitors carry their own risk of metabolic and other side effects.

Purpose of the Study:

• To evaluate the risks of metabolic complications after converting from CNI to mTOR inhibitor therapy in kidney transplant recipients.
• To compare the incidence of new-onset diabetes after transplant (NODAT) and hypercholesterolemia between CNI-based and mTOR inhibitor-based regimens.
• To assess secondary outcomes including acute rejection, opportunistic infections, proteinuria, and anemia.

Main Methods:

• Systematic literature search of PubMed up to September 2013.
• Included nine randomized controlled trials with a total of 2323 kidney transplant patients.
• Meta-analysis of relative risks (RRs) for primary and secondary outcomes.

Main Results:

• mTOR inhibitor conversion was associated with a nonsignificant trend toward increased NODAT (RR 1.32; 95% CI 0.92-1.87).
• A significant increase in hypercholesterolemia was observed with mTOR inhibitors (RR 2.15; 95% CI 1.35-3.41).
• Increased risks of acute rejection, proteinuria, and anemia were noted, with no difference in opportunistic infections.

Conclusions:

• Conversion from CNI to mTOR inhibitors in kidney transplant recipients is linked to a significant increase in hypercholesterolemia.
• The conversion also showed increased risks for acute rejection, proteinuria, and anemia.
• While NODAT risk did not significantly increase, the overall findings suggest careful patient monitoring is necessary.