Asakiene Egle, Rainiene Tatjana, Dainys Balys
Clinic of Nephrology and Urology, Vilnius University Hospital Santariskiu klinikos, Santariskiu 2, 08406 Vilnius, Lithuania.
Medicina (Kaunas). 2005;41 Suppl 1:93-100.
Sirolimus is a new immunosuppressive agent. This study aimed to evaluate the efficiency of sirolimus in patients after renal transplantation and to compare graft function, the frequency of rejection episodes and complications with patients under cyclosporin A treatment. From May 2002 to January 2005 26 renal transplant patients were treated with sirolimus. 13 patients (group A) were treated with sirolimus before renal transplantation and 13 patients (group B) were converted to sirolimus in late period after transplantation because of chronic cyclosporin A nephrotoxicity, chronic graft nephropathy and due to intolerance of cyclosporin A (mean time after transplantation: 18 months). Sirolimus was started as a loading dose 5-6 mg per day and reduced to 2-3 mg per day. Mean sirolimus blood concentration was 8.19+/-6.7 ng/ml. Results were compared according to age, gender, the number of HLA matches, plasma renin activity levels, etc., with 52 patients (control (C) group) under cyclosporin A, mycophenolate mofetil and steroids treatment. During 3 months, the acute rejections were in 30.8% of patients (4/13) and 65.4% of patients (17/26) for group A and group B, respectively (chi2=6.568, p<0.05). Renal function at 12 months: mean serum creatinine was 165.5+/-29 micromol/l vs. 214.2+/-67.9 micromol/l, urea 9.6+/-2.6 mmol/l vs. 13.9+/-9.3 mmol/l. There were no differences in platelet counts between groups, but serum cholesterol value was higher in the patients of group A (8.11+/-0.9 mmol/l vs. 6.54+/-1.4 mmol/l), blood pressure (140+/-13/87+/-14 mmHg vs. 150+/-15/85+/-12 mmHg). Patients were treated for different infections, cytomegalovirus infection and sepsis (28.6% (6/21) vs. 45.2% (19/52) for group A and group B, respectively). Our results have shown that sirolimus in combination with mycophenolate mofetil and steroids is an effective alternative to continuous therapy without cyclosporine.
西罗莫司是一种新型免疫抑制剂。本研究旨在评估西罗莫司在肾移植患者中的疗效，并将其移植肾功能、排斥反应发生率及并发症与接受环孢素A治疗的患者进行比较。2002年5月至2005年1月，26例肾移植患者接受了西罗莫司治疗。13例患者（A组）在肾移植前接受西罗莫司治疗，13例患者（B组）因慢性环孢素A肾毒性、慢性移植肾病及环孢素A不耐受（移植后平均时间：18个月）在移植后期改用西罗莫司治疗。西罗莫司起始负荷剂量为每日5 - 6mg，之后减至每日2 - 3mg。西罗莫司平均血药浓度为8.19±6.7ng/ml。根据年龄、性别、HLA配型数量、血浆肾素活性水平等，将结果与52例接受环孢素A、霉酚酸酯和类固醇治疗的患者（对照组（C组））进行比较。在3个月期间，A组和B组急性排斥反应发生率分别为30.8%（4/13）和65.4%（17/26）（χ2 = 6.568，p < 0.05）。12个月时的肾功能：血清肌酐均值分别为165.5±29μmol/L和214.2±67.9μmol/L，尿素分别为9.6±2.6mmol/L和13.9±9.3mmol/L。两组间血小板计数无差异，但A组患者血清胆固醇值较高（8.11±0.9mmol/L对6.54±1.4mmol/L），血压较高（140±13/87±14mmHg对150±15/85±12mmHg）。两组患者均接受了不同感染、巨细胞病毒感染及败血症的治疗（A组和B组分别为28.6%（6/21）和45.2%（19/52））。我们的结果表明，西罗莫司联合霉酚酸酯和类固醇是一种有效的替代方案，可在不使用环孢素的情况下进行持续治疗。
