Evidence-based Transformation Of Intervention Strategies For Renal Transplantation Based On Tacrolimus

Objective: To reevaluate the systematic evaluation of Tac treatment in renal transplant patients,and to evaluate the methodological quality and reporting quality of relevant studies.Cluster analysis of the efficacy and safety of Tac treatment regimen in kidney transplantation and the reliability of the conclusions is expected to provide basis for the clinical transformation of high-quality evidence and provide reference for clinical practice decision making.Methods: Computer retrieval was performed in PubMed,Embase,The Cochrane Library,Web of Science,Medline,CNKI,Wanfang Database,CBM and VIP Database,and systematic evaluation/meta-analysis of Tac immunotherapy in renal transplant patients was comprehensively collected.By two independent researchers in and out in strict accordance with the standard screening of literature,adopting AMSTAR methodological quality assessment scale and OQAQ scale,the PRISMA inventory report quality evaluation,comprehensive summary of the Tac medication strategy and system,gathering research,qualitative analysis and discussion about the related outcome indexes,refining the current results and future in need of improvement.Results:1.A total of 22 SR papers were included,including 14 in Chinese and 8 in English.Seventeen studies compared Tac with CsA,and five compared Tac with SRL.The AMSTA/OQAQ scale evaluation indicates that the highest score is 8/7 and the lowest score is 3/2,averaging 5.7/4.6.The main problems are lack of top-level design,high risk of retrieval bias,incomplete inclusion and exclusion criteria and unclear conflicts of interest.The PRISMA results showed that the highest score was 23,the lowest score was 13,and the average score was 17.7.The main problems were as follows: failure to meet the requirements of structured summary,failure to provide pre-study program and registration information,failure to provide detailed description of inclusion criteria,failure to report specific retrieval strategies,failure to report relevant funding information,etc.2.According to the included studies,Tac drug regimen was mainly divided into three categories,namely,Tac dual drug regimen:Tac+non-hormonal immunosuppressive agents and Tac+hormones.The first regimen,compared with CsA,could reduce the incidence of acute rejection,with lower renal toxicity and less liver damage.However,the second regimen was studied in a small amount and the main efficacy outcome indicators were not clear,so clinicians used it with caution.Tac combination therapy:Tac+non-hormonal immunosuppressant+hormone,Tac+non-hormonal immunosuppressant+immunoinducer.Such a regimen can effectively control acute rejection,but it may increase the incidence of diabetes.Compared with the combination of CsA,it has less liver damage,and the improvement level of GRF is lower than the combination of SRL.Tac combined therapy:Tac+"non-hormone immunosuppressant"+hormone+immune inducer,which can effectively control acute rejection and reduce the incidence of hyperlipidemia,but the risk of infection is higher than SRL combined therapy.Conclusion:1.The general methodological quality and reporting quality of the current SR literature on Tac immunotherapy in kidney transplantation are not high.Most of the studies have some defects in methodological and reporting standards,which reduce the reliability of the research conclusions and the strength of evidence.2.Tac combined drug regimen is complex and diverse in kidney transplantation.Compared with CsA combined drug regimen,Tac combined drug regimen has better efficacy and safety for patients,such as effective control of the incidence of acute rejection,reduction of liver/kidney damage,and reduction of hyperlipidemia.But with increased diabetes risk of adverse events,relative to SRL combination,its high incidence of postoperative infection,and improve renal function below SRL combination,for the incidence of acute rejection and graft survival rate,the present study results vary,to need to identify high quality research,but based on the overall quality is not high,clinicians should be cautious..3.The future research should be strict in advance the related SR prophase scheme and research strategy,make the process more transparent and rigorous research,at the same time should pay attention to personalized use of drugs and the ratio of specification,suggest follow AMSTAR scale and PRISMA statement calls for practice in order to improve the methodological quality and improve the report specification,in order to provide more valuable high quality documents of evidence,to make it better serve the clinical.