| Objective: To evaluate the efficacy and safety for conversion from cyclosporine A to tacrolimus on survival rate of patients and grafts, transplanted renal function, risk factors of cardiovascular disease and blood glucose after renal transplantation.Methods:We searched the studies on conversion from cyclosporine A to tacrolimus in postoperative treatment for patients with renal transplantation through (1) computer search for MEDLINE (1966-2006), EMBASE (1984-2006), the Chinese Biomedical Database (DBM, 1984-2006), and Cochrane Central Register of Controlled Trials (the Cochrane Library, Issue 4, 2006); (2) hand searching for 8 Chinese specialty periodicals; and (3) some website search engines, such as GOOGLE. We tracked the reference lists of related studies. The studies were selected for eligibility and evaluated for quality with at least two independent reviewers. Data were extracted with cross-check confirmation. A third reviewer was involved when differences in opinion existed. The quality of included studies such as randomization, blinding, allocation concealment was evaluated. Meta-analysis was performed using RevMan 4.2.7 software. After heterogeneity test, data without heterogeneity were pooled using fixed effect model, and those with heterogeneity were solved by sensitivity analysis, subgroup analysis or randomized effect model. Relative risk (RR) and 95% confidence interval (CI) were used for binary data, and weighted mean difference (WMD) with 95% CI or standard mean difference (SMD) with 95% CI for continuous data.Results: Six randomized controlled trials involving 561 patients were included. According to the results of meta-analysis, there was no significant difference on survival rate of patients and grafts within 36 months between CsA group and FK506 group. The relative risks (95% CI) at 3, 6, 12, 24 and 36 months were 0.95 (0.90, 1.01) ,1.02 (0.96, 1.08) ,Not estimable, 1.04 (0.93, 1.17) and Not estimable respectively for the survival rate of patients and 0.99 (0.89, 1.09) ,1.00 (0.95, 1.06) ,1.03(0.97,1.11),1.03 (0.84, 1.27) and 1.08 (0.81, 1.44) respectively for the survival rate of grafts. Conversion from cyclosporine A to tacrolimus could effectively improve the remission rate of acute rejection, with a RR (95% CI) of 1.23 (1.05, 1.44) at 3 months; The conversion could decrease the level of serum creatinine within 3 years. The WMDs (95% CI) at 3, 6, 12 and 36 months were -5.00 (-20.70, 10.70),-24.33 (-65.42, 16.76),-56.05(-133.72, 21.62)and -80.00 (-129.84, -30.16) respectively. The levels of serum total cholesterol and low density lipoprotein were decreased with the conversion. The WMDs (95% CI) at 3, 6 and 12 months were -0.46 (-0.80, -0.12),-0.26 (-0.57, 0.04)and -1.28 (-2.11, -0.45)respectively for total cholesterol ; The WMDs (95% CI) at 3, 6 and 12 months were -0.25 (-0.54, 0.04),-0.01 (-0.65, 0.62)and -0.77 (-1.11, -0.43)respectively for low density lipoprotein. However, there was no significant difference on the level of high density lipoprotein and triglyceride within 12 months between the two groups. The weighted mean difference and 95%CI were0.00 (-0.17, 0.17),0.08 (-0.03, 0.19)and0.08 (-0.05, 0.22)at the end of 3, 6 and 12 months respectively for high density lipoprotein; The weighted mean difference and 95 % CI were -0.50 (-0.91, -0.09),-0.15 (-0.94, 0.65)] and -0.36 (-1.52, 0.81)at the end of 3, 6 and 12 months respectively for triglyceride. The conversion could not change the incidence rate of hypertension significantly, with a RR (95%) of 1.10 (0.57, 2.10) at 3 months. The systolic pressure also could not be decreased significantly with the conversion. The weighted mean difference and 95%CI of 3, 6 ,12 and 36 months were -10.00 (-17.01, -2.99),-5.09 (-11.74, 1.55),-3.00 (-9.08, 3.08)and0.00 (-5.45, 5.45)respectively for systolic pressure. The conversion could lower the level of diastolic pressure within 3 years, with the weighted mean difference and 95%CI of 3, 6,12 and 36 months were -5.00 (-9.07, -0.93),-3.39 (-7.10, 0.32),-4.00 (-7.78, -0.22)and-2.00 (-5.74, 1.74) respectively for systolic pressure. There was no significant difference on the level of blood glucose between the two groups, the weighted mean difference and 95%CI of 3, 6 and 12 months were0.60 (0.01,1.19),0.50 (-0.07, 1.07) and -3.00 (-21.32, 15.32)respectively for blood glucose.Conclusion: Conversion from cyclosporine A to tacrolimus could improve the remission rate of acute rejection, decrease the level of serum creatinine, serum total cholesterol and low density lipoprotein, and lower the level of diastolic pressure. Though there is no significant difference in the survival rate of grafts or patients, the incidence rate of hypertension, systolic pressure and blood glucose.
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