The Comparision Of Proliferation Signal Inhibitors And Calcineurin Inhibitors In The Maintenance Immunosuppression Of Cardiac Transplant Recipients:A Meta-analysis

Objective Although some studies have explored the choice of maintenance immunosuppressive agents in heart transplantation immunotherapy,these studies are relatively small and have a relatively low impact for a long time.Therefore,we make a meta-analysis of the related studies published in recent years,mainly to discuss the comparison between proliferation signal inhibitors(PSI)and calcineurin inhibitors in maintenance therapy.Methods and results Search documents using the keywords "immunosuppression" or "proliferation signal inhibitors" or "calcineurin inhibitors" and "heart transplant" to search Cochran CENTRAL,Pubmed,Web of Science,China knowledge Network,Vip,Wanfang database for retrieval.The data of the continuous variables in the control group and the trial group were collected,and the frequency and sample size of the two classification variables were collected.Then the random effect model was used to statistically analyze the data.After reading summary,full text and data statistics screening,13 studies were obtained,of which 10 were randomized controlled studies(RCT),3 were non-randomized controlled trials(RCTs).At the same time,heart transplantation patients who received PSI or CNI during maintenance period were compared.A summary analysis of 10 studies of reported glomerular filtration rate(GFR)of renal function showed that the use of PSI was significantly higher than that of CNI renal function(9.12(4.97,13.27,95% CI)ml/min,p < 0.0001).The corresponding subgroup analysis showed that GFR increased:13.8(6.48,21.23,95% confidence interval)ml/min,p=0.0002,in patients with normal renal function,and 6.60(1.77,11.42,95% confidence interval)ml/min,p=0.007,in patients with renal insufficiency(RI)after years of survival.A summary analysis of four studies that reported the cardiac allograft vasculopathy(CAV)-related maximum intimal thickness(MIT)showed that the PSI group was-0.07(-0.14,-0.01,95% confidence interval)mm,p=0.03,compared with the CNI group.A summary analysis of five studies that reported CAV-related plaque index(PI)showed that the PSI group was-3.90(-6.28,-1.51,95% CI)%,p = 0.0001,compared with the CNI group(-6.28,-1.51,95% CI).A summary analysis of 8 studies reporting acute cellular rejection(ACR)showed that the incidence of the International Society for Heart and Lung Transplantation(ISHLT)2005 grade 2R in the PSI group was significantly higher than that in the CNI group.The advantage ratio of OR is 2.09(1.19,3.68,95% confidence interval),p = 0.01.Conclusion The results of summary analysis show that PSI is superior to CNI in renal function and CAV,but the incidence of CNI in ACR is lower than that in PSI.Nevertheless,more forward-looking studies are needed to further investigate and confirm the association.