Shabtai Moshe, Ben-Haim Menahem, Zemer Debora, Malinger-Saavedra Patricia, Rosin Dan, Kuriansky Josef, Lustig Shamir, Shabtai Esther L, Shapira Zaki, Ayalon Amram
Departments of Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2002 Nov;4(11 Suppl):935-9.
Cyclosporin A has been associated with severe toxic side effects in patients with familial Mediterranean fever who underwent renal transplantation. Nevertheless, the impact on graft function and survival is not well documented.
To compare long-term graft function and survival, between CsA-based vs. CsA free immunosuppressive protocols in FMF recipients of renal allograft.
Data of FMF recipients were analyzed retrospectively. Graft survival and function and the incidence of acute rejection were correlated to graft source (living donor vs. cadaveric donor), colchicine dose, presence of proteinuria, and immunosuppression protocol (CsA-based triple drug therapy vs. azathioprine-prednisone alone).
There were 35 FMF patients with primary renal grafts (13 from living donors and 22 from cadaveric donors). Mean follow-up was 10.6 +/- 6.05 years. Sixteen patients were on CsA-based triple drug therapy and 19 patients on AZA-Pred alone. Mean overall graft survival was 11.2 +/- 0.6 years and 9.4 +/- 1.36 vs. 11.6 +/- 0.4 years for CsA-treated and AZA-Pred groups respectively (P = 0.05). One-year survival was 94% and 96.6% for CsA-treated vs. non-CsA patients (not significant), but 5 and 10 years survival were 76% and 46%, compared to 94.5% and 86% respectively (P = 0.05 at 5 years and 0.001 at 10 years). Mean serum creatinine at time of data collection was 2.3 +/- 1.5 mg/dl in the CsA group vs. 1.6 +/- 0.7 mg/dl in the AZA-Pred group (P = 0.02). There were 14 and 13 reversible rejection episodes in the AZA-Pred and CsA groups respectively (not significant).
It is suggested that CsA exerts detrimental effects on long-term renal graft function and survival in FMF patients.
环孢素A与接受肾移植的家族性地中海热患者的严重毒副作用相关。然而，其对移植肾功能和存活的影响尚无充分记录。
比较基于环孢素A与不含环孢素A的免疫抑制方案在家族性地中海热肾移植受者中的长期移植肾功能和存活情况。
对家族性地中海热肾移植受者的数据进行回顾性分析。移植肾存活和功能以及急性排斥反应的发生率与移植肾来源（活体供肾与尸体供肾）、秋水仙碱剂量、蛋白尿的存在以及免疫抑制方案（基于环孢素A的三联药物治疗与单独使用硫唑嘌呤-泼尼松）相关。
有35例家族性地中海热患者接受了初次肾移植（13例来自活体供肾，22例来自尸体供肾）。平均随访时间为10.6±6.05年。16例患者接受基于环孢素A的三联药物治疗，19例患者单独接受硫唑嘌呤-泼尼松治疗。环孢素治疗组和硫唑嘌呤-泼尼松组的平均移植肾总存活时间分别为11.2±0.6年和9.4±1.36年，与11.6±0.4年相比（P = 0.05）。环孢素治疗组与非环孢素治疗组的1年存活率分别为94%和96.6%（无显著差异），但5年和10年存活率分别为76%和46%，相比之下，非环孢素治疗组分别为94.5%和86%（5年时P = 0.05，10年时P = 0.001）。数据收集时，环孢素组的平均血清肌酐为2.3±1.5mg/dl，硫唑嘌呤-泼尼松组为1.6±0.7mg/dl（P = 0.02）。硫唑嘌呤-泼尼松组和环孢素组分别有14次和13次可逆性排斥反应（无显著差异）。
提示环孢素A对家族性地中海热患者的长期移植肾功能和存活有不利影响。
