Calcineurin inhibitor sparing with mycophenolate in kidney transplantation: a systematic review and meta-analysis.

Jason Moore, Lee Middleton, Paul Cockwell, Dwomoa Adu, Simon Ball, Mark Little, Andrew Ready, Keith Wheatley, Richard Borrows

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66 Citations (Scopus)


BACKGROUND: Limiting the exposure of kidney transplant recipients to calcineurin inhibitors (CNIs) has potential merit, but there is no clear consensus on the utility of current strategies. In an attempt to aid clarification, we conducted a systematic review and meta-analysis of randomized trials that assessed CNI sparing (minimization or elimination) with mycophenolate as sole adjunctive immunosuppression. METHODS: The search strategy identified trials where CNI sparing was accompanied by the continuation of, or conversion to, mycophenolate and compared with standard or higher dose CNI therapy. Two investigators independently examined each trial for eligibility, quality, and outcome measures. Additional subgroup analyses were assessed: (1) de novo CNI sparing; (2) elective CNI sparing beyond 2 months posttransplantation; and (3) CNI sparing for transplant dysfunction. RESULTS: Nineteen randomized controlled trials met the inclusion criteria permitting analysis of 3312 renal transplant recipients with median follow-up of 12 months. CNI sparing significantly improved glomerular filtration rate (weighted mean difference 4.4 mL/min, 95% confidence interval [CI] 2.9-5.9, P
Original languageEnglish
Pages (from-to)591-605
Number of pages15
Issue number4
Publication statusPublished - 27 Feb 2009


  • Cyclosporine
  • Kidney transplantation
  • Meta-analysis
  • Tacrolimus
  • Mycophenolate


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