Hohage H, Hillebrandt U, Welling U, Zeh M, Heck M, Gerhardt U W, Suwelack B M
Nephrologisches Zentrum Emsland, HD Facility, Lingen, Germany.
Transplant Proc. 2005 Mar;37(2):1036-8. doi: 10.1016/j.transproceed.2004.12.031.
After allogenic transplantations, a dramatic increase in the development of arteriosclerotic plaques can be observed, which might be due to metabolic alterations, changes in the transplant organ, or the immunosuppression regimen. Many studies have demonstrated beneficial effects of tacrolimus compared with cyclosporine with regard to these conditions. These results have suggested that conversion to tacrolimus from cyclosporine is advantageous. Our study investigated whether patients with deteriorating renal function profit from this conversion. Thirty renal transplant patients were studied retrospectively, using data recorded from 3 years before to 3 years after conversion from cyclosporine to tacrolimus. While renal function (GFR) deteriorated progressively under cyclosporine, it stabilized and even improved under tacrolimus (creatinine: DeltaCyc = +1.4 mg/d; DeltaTac = -0.7 mg/dL; GFR: DeltaCyc = -35 mL/min; DeltaTac = 14 mL/min). In addition, uric acid levels (7.0 mg/dL vs 6.4 mg/dL, P < .05) and cholesterol levels (258 mg/dL vs 225 mg/dL, P < .05) were both significantly lower under tacrolimus. Conversion from cyclosporine to tacrolimus is recommended for kidney transplant patients in whom there has been a progressive fall in renal function. It leads to stabilization or even improvement of transplant function and a reduction in cardiovascular risk factors.
在同种异体移植后，可以观察到动脉粥样硬化斑块的形成显著增加，这可能是由于代谢改变、移植器官的变化或免疫抑制方案所致。许多研究表明，在这些情况下，与环孢素相比，他克莫司具有有益效果。这些结果表明，从环孢素转换为他克莫司是有利的。我们的研究调查了肾功能恶化的患者是否能从这种转换中获益。对30例肾移植患者进行了回顾性研究，使用从环孢素转换为他克莫司之前3年到之后3年记录的数据。在使用环孢素期间，肾功能（肾小球滤过率）逐渐恶化，而在使用他克莫司期间则稳定甚至有所改善（肌酐：环孢素组变化量 = +1.4 mg/d；他克莫司组变化量 = -0.7 mg/dL；肾小球滤过率：环孢素组变化量 = -35 mL/min；他克莫司组变化量 = 14 mL/min）。此外，他克莫司治疗期间尿酸水平（7.0 mg/dL 对 6.4 mg/dL，P < 0.05）和胆固醇水平（258 mg/dL 对 225 mg/dL，P < 0.05）均显著降低。对于肾功能逐渐下降的肾移植患者，建议从环孢素转换为他克莫司。这会导致移植功能稳定甚至改善，并降低心血管危险因素。
