Early use of mTOR inhibitors-based immunosuppression in heart transplantation recipients: a systematic review and meta-analysis of randomized controlled trials

The aim of our study is to assess the efficacy and safety of early use of m TOR inhibitors-based immunosuppression compared with standard immunosuppression in heart transplantation recipients. We reviewed eight randomized controlled trials identified from Medline/Pub Med, Embase, web of science, Transplant Library and Cochrane Library to evaluate the effects of m TOR inhibitors therapy on outcomes of biopsy-proven acute rejection,acute rejection associated with hemodynamic compromise, death, cytomegalovirus infection, post-transplant malignancy, cardiac allograft vasculopathy, maximal intimal thickness and renal function. Meta-analysis including 2066recipients showed a significantly lower incidence of biopsy-proven acute rejection, cytomegalovirus infection, cardiac allograft vasculopathy and decreased maximal intimal thickness change. In conclusion, our meta-analysis suggested that early use of m TOR inhibitors-based immunosuppression were more effective and safer compared with standard immunosuppression in heart transplant recipients, especially in reducing acute rejection, cytomegalovirus infection, cardiacallograft vasculopathy and preserving renal function when combined with reduced calcineurin inhibitors.