Tacrolimus versus cyclosporine immunosuppression in lung transplantation: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: The relative efficacy of calcineurin inhibitors tacrolimus and cyclosporine in lung transplantation remains unclear. To clarify, we conducted a systematic review and meta-analysis. METHODS: We searched through EMBASE, MEDLINE and Cochrane CENTRAL until 23 October 2023 for randomised trials comparing tacrolimus with cyclosporine in lung transplant recipients. Data extraction and bias risk assessment were done independently. Analyses included random effects pairwise meta-analysis and trial sequential analysis, with GRADE system for evidence certainty. RESULTS: We found four eligible trials totalling 662 patients. Tacrolimus significantly reduces the risk of chronic lung allograft dysfunction (RR 0.46, high certainty) and likely decreases acute rejection risk (RR 0.83, moderate certainty), with no clear difference in mortality (RR 1.08, low certainty). It may raise new-onset diabetes mellitus (RR 4.17, low certainty) and renal dysfunction risks (RR 1.27, low certainty). CONCLUSION: Tacrolimus likely lowers acute rejection and chronic dysfunction risks in lung transplant recipients without improving survival rates. However, it might increase the chances of developing diabetes mellitus and renal dysfunction. These findings guide the choice between tacrolimus and cyclosporine, balancing benefits against potential risks.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.012 | 0.002 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".