Maintenance therapy with triple versus double immunosuppressive regimen in renal transplantation: a meta-analysis

The purpose of this study was to compare the effect of triple immunosuppressive maintenance therapy (cyclosporine, azathioprine, and prednisolone) with that of double therapy (cyclosporine and prednisolone) in renal transplant patients using graft failure, mortality, and acute rejection episodes as outcome measures.

A systematic overview of articles published between 1984 and 1995 was done. MEDLINE, Science Citation Index, reference lists, and expert files were searched. Of 449 originally identified studies, five controlled trials were finally selected. Information was retrieved on the topics of methodological quality, baseline characteristics, interventions, and outcomes. The Mantel-Haenszel fixed effect method was used to combine results from different studies.

Pooled analysis did not show a statistically significant difference between triple-drug therapy and double-drug therapy in the main outcome of graft failure (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.61-1.16), survival (OR, 0.83; 95% CI, 0.57-1.21), or the occurrence of acute graft rejection (OR, 1.02; 95% CI, 0.76-1.36). There was a nonsignificant trend for better graft survival under triple therapy. A lower withdrawal rate suggests a more stable immunosuppressive effect on triple therapy.

There is no statistically significant difference in the long-term management of renal transplant recipients between the two treatment regimens.