Impact of rapamycin on delayed graft function in kidney transplant recipients: a meta-analysis

Objective To evaluate the effect of rapamycin on DFG (delayed graft function in kidney transplant) recipients through a systematic review and meta-analysis. Methods We searched PubMed, Embase, Cochrane Library, and other databases for studies assessing rapamycin use in kidney transplantation with a focus on DGF. The search was conducted from the time of database construction to December 2024. Literature search and quality evaluation were conducted by two researchers. Data were analyzed using RevMan 5.3, with odds ratio (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. The meta-analysis was performed with Q-I-2; fixed model for I-2 < 50%; sensitivity analysis for I-2 >= 50%. p Values < 0.05 were considered statistically significant. Results Nine studies (n = 9,219) were included. Rapamycin was associated with an increased risk of DGF (OR = 1.29, 95% CI: 1.04-1.58), with a prolonged DGF duration (MD = 8.86, 95% CI: 3.84-13.89). No significant differences were found in graft survival (OR = 1.40, 95% CI: 0.72-2.73); patient survival (OR = 1.89, 95% CI: 0.84-4.26), or rejection incidence (OR = 1.22, 95% CI: 0.78-1.90). Conclusions Rapamycin significantly increases the risk and duration of DGF after kidney transplantation. However, it does not appear to affect long-term outcomes such as graft survival or rejection rates. These findings suggest that rapamycin should be used cautiously in transplant recipients at risk for DGF, and further studies are needed to optimize immunosuppressive strategies for this population.