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Retirada electiva de ciclosporina después de un trasplante renal. Un metanálisis
B L Kasiske1, K Heim-Duthoy, J Z Ma
1Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis 55415.
JAMA
|January 20, 1993
Resumen
La interrupción electiva de la ciclosporina después del trasplante renal aumenta las tasas de rechazo agudo, pero no afecta el injerto a corto plazo o la supervivencia del paciente. Los efectos a largo plazo de la retirada de ciclosporina requieren más investigación.
Área de la Ciencia:
- Nefrología Nefrología.
- La inmunosupresión es la inmunodepresión.
- Medicina del trasplante Medicina del trasplante.
Sus antecedentes:
- La ciclosporina es un inmunosupresor clave después del trasplante renal.
- La interrupción de la inmunosupresión es deseable, pero conlleva riesgos.
Objetivo del estudio:
- Evaluar la seguridad y eficacia de la retirada electiva de ciclosporina después del trasplante renal.
- Evaluar el impacto en el rechazo agudo, la pérdida de injerto y la mortalidad.
Principales métodos:
- Revisión sistemática y metanálisis de ensayos controlados.
- Buscado MEDLINE y bibliografías para estudios relevantes.
- Resultados comparados entre los grupos de abstinencia de ciclosporina y de continuación/no uso.
Principales resultados:
- Aumento de las tasas de rechazo agudo observadas con la retirada de ciclosporina (P < .001).
- No hay diferencias significativas en la pérdida de injerto a corto plazo o la mortalidad.
- Los ensayos aleatorizados sugirieron una mejor supervivencia del injerto después de la retirada (P = 0,049).
Conclusiones:
- La abstinencia electiva de ciclosporina aumenta el rechazo agudo pero no la supervivencia a corto plazo del injerto/paciente.
- Los resultados a largo plazo de la retirada de ciclosporina siguen siendo inciertos.
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