Fish oil for kidney transplant recipients.
Lim AKH, Manley KJ, et al.Cochrane Database of Systematic Reviews 2016; 8: CD005282.
Aims
To examine the benefits and harms of fish oil treatment in improving the adverse effects of calcineurin-inhibitor (CNI)-based immunosuppressive therapy in kidney transplant recipients.
Interventions
The Cochrane Kidney and Transplant Specialised Register (up to 17 March 2016) were searched for randomised controlled trials (RCTs) and quasi-RCTs examining fish oils in kidney transplant recipients. Studies included all recipients of cadaveric or living kidney transplants on a CNI based immunosuppressive protocol.
Participants
15 studies comprising 733 patients were included in the analysis.
Outcomes
Measured outcomes included patient survival, graft failure, acute rejection, CNI toxicity, cardiovascular events, adverse effects, compliance, kidney function, blood pressure, and serum lipid levels.
Follow-up
12 months
CET Conclusions
This Cochrane review is an update of a previous study investigating the role of fish oils in renal transplant recipients taking calcineurin inhibitors. The authors hypothesise that fish oil might reduce the risk of rejection (via immunomodulatory effects) and improve endothelial function. Fifteen small studies of variable quality are identified, and meta-analysis demonstrates no difference in graft or patient survival or acute rejection rate. Whilst there is a significantly lower serum creatinine in the fish oil treated recipients, neither GFR nor creatinine clearance differed and there is significant heterogeneity that remains unexplained in subgroup analyses. It is possible that this relates to the large variation in fish oil dose used in the studies (from 2 to 8 g/day). The authors conclude, very sensibly, that current RCT evidence does not support the routine use of fish oil in renal transplant recipients. They make some useful suggestions as to direction of future trials.
Quality notes
Quality assessment not appropriate.
Trial registration
None