Almeida M, Martins L S, Dias L, Figueiredo M J, Henriques A C, Sarmento A M, Cabrita A
Department of Nephrology, Hospital Geral de Santo António, Oporto, Portugal.
Transplant Proc. 2005 Jul-Aug;37(6):2777-80. doi: 10.1016/j.transproceed.2005.06.088.
Calcineurin inhibitors (CI) are associated with nephrotoxicity that might reduce long-term graft survival. We report our experience with sirolimus (SRL) conversion among a population of kidney and kidney pancreas transplant recipients.
Thirty transplant recipients (6 women, 24 men; age 41 +/- 10.5 years old) were converted to SRL therapy at 25.97 +/- 32.5 months after transplantation. Indications for conversion were: intolerance to mycophenolate mofetil (n = 13), diabetes mellitus (n = 3), CI nephrotoxicity (n = 11), CI nephrotoxicity with chronic allograft rejection (n = 2), and side effects of azathioprine (n = 1). Follow-up after conversion is 3 to 45 months.
No significant changes were observed in the 3 months postconversion in renal function, hematological profile, and mean arterial blood pressure. In contrast there was a significant increase in cholesterol values (pre: 198.7 +/- 49.4, versus post 221.2 +/- 60.8, P = .018). At a follow-up of 15.2 +/- 9.9 months after conversion two patients (6.7%) died with functioning allograft (one because of infection and one to myocardial infarct) three kidney allografts (10.7%) have been lost: two chronic rejection; one infection. In two patients SRL therapy was discontinued (one infection, one refractory edema). Neither significant change in renal function nor episodes of acute rejection were observed.
Conversion to SRL was safe. There was no deterioration in renal function nor episodes of acute rejection. There was a significant increase in cholesterol values after conversion. The size of the sample and the time of follow-up may have determined our results.
钙调神经磷酸酶抑制剂（CI）与肾毒性相关，这可能会降低移植物的长期存活率。我们报告了在肾移植和肾胰联合移植受者群体中转换为西罗莫司（SRL）治疗的经验。
30例移植受者（6名女性，24名男性；年龄41±10.5岁）在移植后25.97±32.5个月转换为SRL治疗。转换的指征为：对霉酚酸酯不耐受（n = 13）、糖尿病（n = 3）、CI肾毒性（n = 11）、CI肾毒性合并慢性移植物排斥反应（n = 2）以及硫唑嘌呤的副作用（n = 1）。转换后的随访时间为3至45个月。
转换后3个月，肾功能、血液学指标和平均动脉血压均无显著变化。相比之下，胆固醇值显著升高（转换前：198.7±49.4，转换后：221.2±60.8，P = 0.018）。转换后随访15.2±9.9个月时，两名患者（6.7%）在移植物功能良好的情况下死亡（1例死于感染，1例死于心肌梗死），3个肾移植物（10.7%）丢失：2例为慢性排斥反应；1例为感染。两名患者停用了SRL治疗（1例为感染，1例为难治性水肿）。未观察到肾功能的显著变化，也未发生急性排斥反应。
转换为SRL治疗是安全的。肾功能没有恶化，也没有发生急性排斥反应。转换后胆固醇值显著升高。样本量和随访时间可能决定了我们的结果。
