Hardinger Karen L, Brennan Daniel C, Lowell Jeffrey, Schnitzler Mark A
St. Louis College of Pharmacy, St. Louis, Missouri, USA.
Transpl Int. 2004 Nov;17(10):609-16. doi: 10.1007/s00147-004-0768-6. Epub 2004 Oct 29.
This study examined consequences of gastrointestinal (GI) complications and mycophenolate mofetil (MMF) discontinuation on long-term outcomes in patients who received MMF at transplantation and had graft function 12 months post-transplantation. Data were obtained from the United States Renal Data System for cadaveric renal transplant recipients between 1995 and 1998. GI complications or MMF discontinuation occurred in 27.4% and 17.5% of patients, respectively. MMF was discontinued in 21.3% of patients with GI complications and 16.0% of patients without (P<0.00001). Four-year graft survival was reduced from 87.1% to 82.3% (P=0.091) with MMF discontinuation, to 83.0% (P=0.001) with GI complications, and to 70.2% (P<0.0001) with GI complications and MMF discontinuation. While the retrospective nature of this work cannot prove causality, which will require future prospective studies, both GI complications and MMF withdrawal are associated with increased risk of graft loss and may warrant further study in the management of transplant recipients.
本研究调查了胃肠道（GI）并发症和停用霉酚酸酯（MMF）对移植时接受MMF且移植后12个月移植肾功能的患者长期预后的影响。数据取自1995年至1998年间美国肾脏数据系统中尸体肾移植受者的资料。GI并发症和停用MMF分别发生在27.4%和17.5%的患者中。在有GI并发症的患者中，21.3%停用了MMF，在无GI并发症的患者中，16.0%停用了MMF（P<0.00001）。停用MMF后，四年移植肾存活率从87.1%降至82.3%（P=0.091），发生GI并发症后降至83.0%（P=0.001），发生GI并发症且停用MMF后降至70.2%（P<0.0001）。虽然本研究的回顾性性质无法证明因果关系（这需要未来的前瞻性研究），但GI并发症和停用MMF均与移植肾丢失风险增加相关，可能值得在移植受者管理方面进行进一步研究。
