关键词: 肾移植, 他克莫司, 环孢素, Meta分析, 系统评价, 急性排斥反应

Abstract: Abstract:Objective  To explore the inhibitory effectiveness of  tacrolimus(Tac)  and ciclosporin(Csa) on acute rejection  in patients after kidney transplantation  and to provide guidance for the selection of immunosuppression medicine after kidney transplantation.Methods Computer searches were in Medline and  CNKI．The randomized controlled trials (RCT) comparing Tac with CsA in treatment of  acute rejection after  transplantation were included．Data was extracted independently by two reviewers．The methodological quality was assessed by the Jadad Score．Statistical analysis was performed with RavMan 5.0．Results 226 studies were found at first，and 31 RCTs comparing Tac with CsA in treatment of  acute rejection after kidney transplantation were identified at last．Meta-analysis showed that  2 and 14 studies about  biopsy-proved acute rejection during half a year and 1 year after transplantation  were included.The morbidities  of acute rejection during half a year and 1 year after transplantation in Tac group were  lower than those in CsA group with statistical difference,half a year RR 0.49，95%CI(0.37，0.67)，P<0.01;1 year RR 0.65，95%CI(0.56，0.75)，P<0.01.For steriod-resistant acute rejection 4 and 7 studies were included during half a year and 1 year after transplantation. The morbidities of acute rejection during half a year and 1 year after transplantation in Tac group were lower than those in CsA group with statistical difference,half a year RR 0.41，95%CI(0.30，0.57)，P<0.01; 1 year RR 0.54，95%CI(0.37，0.78)，P=0.01.Conclusion The effectiveness of Tac in inhibiting acute rejection after kidney transplantation is better than CsA.
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Key words: kidney transplantation, tacrolimus, cyclosporin A, Meta-analysis, systematic review, acute rejection