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Tacrolimus is commonly used post-transplant, while once-daily dosing may enhance adherence. This meta-analysis compared clinical outcomes of once-daily versus twice-daily prolonged-release tacrolimus in de novo renal transplant recipients using randomized controlled trials, pooling effect estimates with random-effects models and applying trial sequential analysis.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/efficacy-and-safety-of-once-daily-prolonged-release-tacrolimus-versus-twice-daily-tacrolimus-in-kidney-transplant-recipients-a-meta-analysis-and-trial-sequential-analysis/436746/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/efficacy-and-safety-of-once-daily-prolonged-release-tacrolimus-versus-twice-daily-tacrolimus-in-kidney-transplant-recipients-a-meta-analysis-and-trial-sequential-analysis/436746.png","ImageObject",300,407,{"name":92,"@type":93},"Sarah ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical question does this study address?","Question",{"text":113,"@type":114},"It compares efficacy and safety between once-daily and twice-daily prolonged-release tacrolimus in de novo kidney transplant recipients.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How were studies selected and effects estimated?",{"text":118,"@type":114},"Randomized controlled trials evaluating once-daily versus twice-daily tacrolimus in de novo renal transplantation were identified up to July 2022, with pooled risk ratios and standardized mean differences calculated using a random-effects model.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the main efficacy and safety findings?",{"text":122,"@type":114},"Across nine included RCTs, biopsy-confirmed acute rejection and renal function showed no significant differences, and risks of graft failure, death, and adverse events in the first year were similar between dosing strategies.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},436746,1790764448,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":46,"preview_page_count":4},962085320529,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","J Chin MedAssoc  \nOriginal article  \nEfficacy and safety of once-daily prolongedrelease tacrolimus versus twice-daily tacrolimusin kidney transplant recipients: A meta-analysis and trial sequential analysis  \nTair-Shin Wanga,b, Kuan-Hua Huangc, Kuan-Chun Hsuehd, Hsin-An Chene,f, Ka-Wai Tame, Shu-Hui Sunb, Cheng-Fong Cheng, Chien-Ying Wangh, Min-Che Tungi, Yuan-Hung Wanga,j,*  \naGraduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.; bDepartment of Pharmacy, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.; cDepartment of Urology, Chi Mei Medical Center, Tainan, Taiwan, ROC.; dDivision of General Surgery, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.; eDivision of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC.; fTMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan, ROC.; gDepartment of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.; hDepartment of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.; iDivision of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.; jDepartment of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC.  \nAbstract  \nBackground: Kidney transplantation is the most important treatment for end-stage renal disease. Immunosuppressive therapies can prevent acute rejection for kidney transplant recipients. Tacrolimus is usually administered to prevent graft rejection after transplantation. Previous studies have indicated that once-daily tacrolimus may improve medication adherence. Therefore, this metaanalysis aimed to compare clinical outcomes between once-daily and twice-daily tacrolimus in de novo renal transplant patients. Methods: Eligible studies were identified from the Cochrane Library Database, PubMed, and Embase until July 2022. Those randomized controlled trials (RCTs) evaluating once-daily versus twice-daily tacrolimus formulations in de novo renal transplantation were included. A summary risk ratio (RR) and standardized mean difference (SMD) with the 95% confidence interval (CI) were estimated using a random-effects model.  \nResults: In total, nine RCTs were included. There were no differences in biopsy-confirmed acute rejection rates between patients with once-daily and those with twice-daily tacrolimus (RR, 0.91; 95% CI, 0.73-1. 13) in 12 months. Regarding renal function, there was no significant difference between the once-daily and twice-daily tacrolimus groups (SMD, −0 .03; 95% CI, −0.12 to 0 .07) . In addition, the risk of graft failure, death, and adverse events in the first year was similar for the once-daily and twice-daily tacrolimus groups. Conclusion: Our major findings suggest that de novo renal transplantation recipients receiving once-daily tacrolimus immediately after transplantation have comparable efficacy and safety with those recipients who received twice-daily tacrolimus. Therefore, once-daily tacrolimus medication can be an alternative for de novo renal transplantation recipients.  \nKeywords: De novo renal transplantation; Immunosuppressive agents; Once-daily; Twice-daily; Tacrolimus  \n1. INTRODUCTION  \nEnd-stage renal disease (ESRD) occurs when chronic kidney disease, the progressive loss of renal function, reaches an advanced  \n* Address correspondence. Prof. Yuan-Hung Wang, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250, Wu-Hsing Street, Taipei 110, Taiwan, [ROC. E-mail address: d508091002@tmu.edu.tw](ROC. E-mail address: d508091002@tmu.edu.tw) (Y-H Wang). Author contributions: Dr. Tair-Shin Wang and Dr. Kuan-Hua Huang contributed equally to this work.  \nConflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or mat","cbCaijj0b7w1IwZm","https://ap.wps.com/l/cbCaijj0b7w1IwZm","pdf",1621408,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n# Introduction","[{\"question\":\"What clinical question does this study address?\",\"answer\":\"It compares efficacy and safety between once-daily and twice-daily prolonged-release tacrolimus in de novo kidney transplant recipients.\"},{\"question\":\"How were studies selected and effects estimated?\",\"answer\":\"Randomized controlled trials evaluating once-daily versus twice-daily tacrolimus in de novo renal transplantation were identified up to July 2022, with pooled risk ratios and standardized mean differences calculated using a random-effects model.\"},{\"question\":\"What were the main efficacy and safety findings?\",\"answer\":\"Across nine included RCTs, biopsy-confirmed acute rejection and renal function showed no significant differences, and risks of graft failure, death, and adverse events in the first year were similar between dosing strategies.\"}]","Efficacy and safety of once-daily prolonged-release tacrolimus versus twice-daily tacrolimus in kidney transplant recipients - A meta-analysis and trial sequential analysis | PDF",1790678923]