Valente John F, Hricik Donald, Weigel Kelly, Seaman David, Knauss Thomas, Siegel Christopher T, Bodziak Kenneth, Schulak James A
Department of Surgery, Division of Nephrology, University Hospitals of Cleveland, Cleveland, OH, USA.
Am J Transplant. 2003 Sep;3(9):1128-34. doi: 10.1034/j.1600-6143.2003.00185.x.
Mycophenolate mofetil (MMF) and sirolimus impair wound healing. We compared sirolimus vs. MMF to determine the relative impact on surgical complications and wound healing in adult kidney transplant recipients. This retrospective, single center study of 235 adult kidney transplants performed between 1 January 2000 and 31 January 2002 identified 158 adult, kidney-only recipients treated with tacrolimus and prednisone, from which two groups were defined: group 1 (n = 84) received MMF, group 2 (n = 74) received sirolimus. The incidence of fluid collections, wound problems, dehiscence, and urine leak were compared. A multivariate stepwise logistical regression analysis was performed to identify risk factors. The overall incidence of complications was 21.5%, with rates significantly lower in group 1 (2.4%) vs. group 2 (43.2%, p < 0.0001). Regression analysis showed only sirolimus (p < 0.001) and hypo-albuminemia (p = 0.006) to independently correlate with complication occurrence. In subanalyses, lymphoceles correlated only with sirolimus (p = 0.003), while other wound problems also correlated with higher body mass index (p = 0.067). The use of sirolimus, tacrolimus and prednisone was associated with a greater incidence of lymphoceles, non-lymphocele perinephric fluid collections and other consequences of poor wound healing, as compared to contemporary patients treated with MMF, tacrolimus and prednisone.
霉酚酸酯（MMF）和西罗莫司会损害伤口愈合。我们比较了西罗莫司与MMF，以确定其对成年肾移植受者手术并发症和伤口愈合的相对影响。这项回顾性单中心研究纳入了2000年1月1日至2002年1月31日期间进行的235例成人肾移植手术，确定了158例仅接受肾移植的成年受者，他们接受了他克莫司和泼尼松治疗，并分为两组：第1组（n = 84）接受MMF，第2组（n = 74）接受西罗莫司。比较了积液、伤口问题、裂开和尿漏的发生率。进行多因素逐步逻辑回归分析以确定危险因素。并发症的总发生率为21.5%，第1组（2.4%）的发生率显著低于第2组（43.2%，p < 0.0001）。回归分析显示，只有西罗莫司（p < 0.001）和低白蛋白血症（p = 0.006）与并发症的发生独立相关。在亚分析中，淋巴囊肿仅与西罗莫司相关（p = 0.003），而其他伤口问题也与较高的体重指数相关（p = 0.067）。与接受MMF、他克莫司和泼尼松治疗的当代患者相比，使用西罗莫司、他克莫司和泼尼松与淋巴囊肿、非淋巴囊肿性肾周积液以及其他伤口愈合不良后果的发生率更高有关。
