Hohage H, Welling U, Zeh M, Gerhardt U, Suwelack B
Nephrologisches Zentrum Emsland, Lingen, Germany.
Transplant Proc. 2005 May;37(4):1898-9. doi: 10.1016/j.transproceed.2005.02.113.
To improve long-term kidney graft function, acute graft rejection, hyperlipidemia, hypertension, and toxic influences must be avoided because they may contribute to chronic allograft nephropathy. Many studies have demonstrated greater efficacy and tolerability of tacrolimus compared with cyclosporine with regard to these conditions. Our study investigated whether 30 patients with deteriorating renal function benefitted from conversion to tacrolimus based upon a retrospective analysis using data recorded from 3 years before to 3 years after conversion. Renal function (GFR) deteriorated progressively under cyclosporine (creatinine: baseline 1.5 mg/dL; delta(Cyc) = +1.4 mg/dL within 3 years; GFR: delta(Cyc) = -35 mL/min within 3 years). After switching to tacrolimus, kidney function stabilized and even improved (creatinine: baseline after switching 2.9 mg/dL; delta(Tac) = -0.7 mg/dL; GFR: delta(Tac) = 14 mL/min). Conversion from cyclosporine to tacrolimus is recommended for patients with a kidney transplant in which there has been a progressive decrease in renal function. It may lead to stabilization of or even improvement in transplant function.
为改善肾移植长期功能，必须避免急性移植排斥、高脂血症、高血压及毒性影响，因为它们可能导致慢性移植肾肾病。许多研究表明，在这些方面，他克莫司较环孢素具有更高的疗效和耐受性。我们的研究基于一项回顾性分析，调查了30例肾功能恶化患者在转换为他克莫司治疗后是否获益，该分析使用了转换前3年至转换后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（肌酐：基线值1.5mg/dL；3年内环孢素组变化量（delta(Cyc)）= +1.4mg/dL；肾小球滤过率：3年内环孢素组变化量（delta(Cyc)）= -35mL/min）。转换为他克莫司后，肾功能稳定甚至有所改善（肌酐：转换后基线值2.9mg/dL；他克莫司组变化量（delta(Tac)）= -0.7mg/dL；肾小球滤过率：他克莫司组变化量（delta(Tac)）= 14mL/min）。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。这可能会使移植肾功能稳定甚至改善。
