Maintenance immunosuppression in heart transplantation: insights from network meta-analysis of various immunosuppression regimens

AbstractPrevious studies have reported superiority of mechanistic target-of-rapamycin (mTOR) antagonists (mTA) over calcineurin inhibitors (CNI) as part of maintenance immunosuppression (IS) in mitigating cardiac allograft vasculopathy (CAV) after heart transplantation (HT). MEDLINE and EMBASE were searched through October 2019 for studies comparing maintenance IS with mTA  + antimetabolites (AM), CNI + mTA or CNI + AM post HT. The main outcomes were all-cause mortality, CAV, acute rejection, CMV infections, and change in eGFR. To compare different IS antagonists, a random-effects network meta-analysis was performed. We used p-scores to rank best treatment s per outcome. Our search identified fifteen eligible studies (5 studies comparing mTA + AM vs. CNI + AM, 9 comparing CNI + mTA vs. CNI + AM, 1 comparing mTA + AM vs. CNI + mTA, 8 using everolimus and 7 sirolimus as mTA) reporting the selected outcomes. We did not identify an y statistical difference in all-cause mortality among the three IS regimens without heterogeneity among studies. CAV rates were significantly lower with CNI + mTA (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.3–0.92). Acute rejection rates were significantly lower with CNI + AM (OR 0.26, 95% CI 0.12–0.56) and with CNI + mTA (OR 0.16, 95% CI 0.07–0.33) compared with mTA + AM without significant heterogeneity (I2 = 43%,p = 0.9). CMV infections were significantly lower with mTA +â€...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research