Fish oil for kidney transplant recipients
Editorial Group: Cochrane Renal Group
Published Online: 18 APR 2007
Assessed as up-to-date: 16 JAN 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Lim AKH, Manley KJ, Roberts MA, Fraenkel MB. Fish oil for kidney transplant recipients. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005282. DOI: 10.1002/14651858.CD005282.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 APR 2007
Calcineurin inhibitors used in kidney transplantation for immunosuppression have adverse effects that may contribute to nephrotoxicity and increased cardiovascular risk profile. Fish oils are rich in very long chain omega-3 fatty acids, which may reduce nephrotoxicity by improving endothelial function and reduce rejection rates through their immuno-modulatory effects. They may also modify the cardiovascular risk profile. Hence, fish oils may potentially prolong graft survival and reduce cardiovascular mortality.
To assess the benefits and harms of fish oil supplementation on kidney transplant recipients on a calcineurin inhibitor-based immunosuppressive regimen.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library, issue 2 2005), MEDLINE (1966-April 2005) and EMBASE (1980-April 2005).
All randomised controlled trials (RCTs) and quasi-RCTs of fish oils in kidney transplant recipients on a calcineurin inhibitor-based immunosuppressive regimen. RCTs of fish oil versus statins were included.
Data collection and analysis
Data was extracted and the quality of studies assessed by two authors, with differences resolved by discussion with a third independent author. Dichotomous outcomes were reported as risk ratio (RR) and continuous outcome measures were reported as the mean difference (MD) with 95% confidence intervals using the random effects model. Heterogeneity was assessed using a Chi² test on n-1 degrees of freedom and the I² statistic. Data not suitable for pooling were tabulated and described.
Sixteen studies (733 patients) were suitable for analysis. Fish oil did not significantly affect patient or graft survival, acute rejection rates, calcineurin inhibitor toxicity or renal function, when compared to placebo. Fish oil treatment was associated with a lower diastolic blood pressure (MD 4.5 mmHg; P = 0.004) compared to placebo. Patients receiving fish oil for more than six months had a modest increase in HDL (MD 0.12 mmol/L; P = 0.01) compared to placebo. Fish oil effects on lipids were not significantly different from low-dose statins. There was insufficient data to analyse cardiovascular outcomes. Fishy aftertaste and gastrointestinal upset were common but did not result in significant patient drop-out.
There is insufficient evidence from currently available RCTs to recommend fish oil therapy to improve renal function, rejection rates, patient survival or graft survival. The improvements in HDL cholesterol and diastolic blood pressure were too modest to recommend routine use. To determine a benefit in clinical outcomes, future RCTs will need to be adequately powered with these outcomes in mind.
Plain language summary
Fish oil for kidney transplant recipients
This review set out to assess any benefit or harm in using fish oil to reduce the risk of kidney damage and heart disease in people who have had a kidney transplant and are receiving standard drugs to prevent rejection. Information from 16 studies was used and showed that fish oils provide a slight improvement in HDL cholesterol and diastolic blood pressure. These studies did not provide enough information on the differences in the risk of death, heart disease, kidney transplant rejection or kidney function between patients receiving fish oils and those receiving placebo. There appeared to be no harmful effects of taking fish oil. The benefits of taking fish oil after a kidney transplant are a mild improvement in some heart disease risk factors. There was not enough information to show any benefit in preventing heart disease or reduction in kidney function. Larger, better studies are needed before regular use of fish oil can be recommended.
抗排斥藥Calcineurin (鈣蛋白) 抑制劑使用於腎臟移植以抑制免疫反應，但產生的不良反應可能有腎毒性及增加心血管的風險。魚油富含長鏈omega3脂肪酸，可改善血管內皮狀況，進而減少腎毒性和透過其免疫調節作用，降低排斥率，它亦可調節心血管疾病的危險因子。因此，魚油基本上可以延長移植腎的存活期，並且降低心血管的死亡率。
我們搜尋了Cochrane對照試驗註冊資料庫 (CENTRAL：於Cochrane Library資料庫中，2005年2月發佈) 、MEDLINE (自1966年至2005年4月) 和EMBASE (自1980年至2005年4月) 。
所有「有服用魚油」並接受「以calcineurin抑制劑為基礎的免疫抑制療程」的腎移植接受者，之所有的隨機對照試驗 (RCTs) 和準隨機對照試驗 (quasiRCTs) 皆納入研究分析；比較服用魚油和史達汀 (statins) 類藥物的隨機對照試驗亦納入分析。 Data collection and analysis
資料由兩位作者篩選並評估試驗的品質，若有意見不同則與獨立的第三位作者討論議決。分岐的結果以相對風險 (RR) 來表示，而連續尺標結果的評估則利用隨機作用模式，並以均值差 (MD) 和95% 的信賴區間來表示。異質性則利用卡方試驗 (Chi2 test) 來測n1的自由度 (degrees of freedom) ，並以I2統計。不適合聚合 (pooling) 一起的資料會列表描述。
16個試驗共733位受試者符合標準而納入分析。與安慰劑比較時，魚油並未顯著地影響病人或移植腎存活率、急性排斥發生率、calcineurin抑制劑的毒性或腎功能；但與安慰組比較，服用魚油組能降低舒張壓 (MD平均：4.5 mmHg；P = 0.004) 。服用魚油超過6個月的病人，其HDL與安慰劑組相比，也有稍微的增加 (MD：0.12 mmol/L；P = 0.01) 。魚油對脂質的作用效果與低劑量的史達汀 (statins) 相比，沒有顯著的差異性。因資料不足而無法分析魚油對心血管的影響。雖然服用魚油常會嘔出魚油味和腸胃道不適，但病人並不會因此而停止服用魚油。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。