Falkiewicz K, Kamińska D, Nahaczewska W, Boratyńska M, Owczarek H, Klinger M, Woźniak M, Patrzałek D, Szyber P
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, ul. Traugutta 57/59, 50-417 Wroclaw, Poland.
Transplant Proc. 2006 Jan-Feb;38(1):119-22. doi: 10.1016/j.transproceed.2005.12.083.
The aim of the study was to assess impaired tubular phosphate reabsorption and renal function among patients on cyclosporine- or tacrolimus-based immunosuppression for 2 years after kidney transplantation. Among 60 cadaveric kidney allograft recipients observed for 48 months, 40 received cyclosporine, azathioprine, and prednisone (group A and B). Group C consisted of 20 patients receiving tacrolimus with steroid withdrawal at 3 months after transplantation. Renal function and calcium-phosphate metabolism-iPTH, 25-OHD, 1,25(OH)(2)D concentration, phosphate reabsorption (TRP; mmol/L), and tubular maximum phosphate reabsorption per glomerular filtration rate (TmPO(4)/GFR; mmol/L)-were assessed at 1, 6, 12, 18, and 24 months (groups A and C) or 24, 30, 36, 42, and 48 months (group B). Renal function after 24 months of observation was significantly better among tacrolimus-treated patients (serum creatinine concentration mumol/L; C: 94.6 +/- 16.8 vs A: 110.5 +/- 22.1 vs B: 121.1 +/- 30.9; P < .05). Among tacrolimus-treated recipients, TRP and TmPO(4)/GFR remained within normal values during the whole observation period. In groups A and B, TRP improved during the first year of observation; after 2 years it reached values observed in group C (TRP: A: 0.67 +/- 0.1; B: 0.72 +/- 0.13; C: 0.76 +/- 0.07; P = NS), whereas TmPO(4)/GFR remained low in group A after 2 years (A: 0.78 +/- 0.19; B: 0.91 +/- 0.25; C: 0.94 +/- 0.15; P < .05). Tacrolimus-treated patients exhibit significantly faster recovery from tubular phosphate reabsorption impairment compared with cyclosporine-treated recipients. Tacrolimus-based immunosuppression led to better kidney allograft function during 2-year observation.
本研究的目的是评估肾移植后接受基于环孢素或他克莫司的免疫抑制治疗2年的患者肾小管磷重吸收受损情况及肾功能。在60例接受尸体肾移植并观察48个月的患者中，40例接受环孢素、硫唑嘌呤和泼尼松治疗（A组和B组）。C组由20例在移植后3个月停用类固醇并接受他克莫司治疗的患者组成。在第1、6、12、18和24个月（A组和C组）或第24、30、36、42和48个月（B组）评估肾功能和钙磷代谢指标——iPTH、25-OHD、1,25(OH)₂D浓度、磷重吸收（TRP；mmol/L）以及每肾小球滤过率的肾小管最大磷重吸收（TmPO₄/GFR；mmol/L）。观察24个月后，接受他克莫司治疗的患者肾功能明显更好（血清肌酐浓度，μmol/L；C组：94.6±16.8，A组：110.5±22.1，B组：121.1±30.9；P<.05）。在接受他克莫司治疗的受者中，整个观察期内TRP和TmPO₄/GFR均保持在正常范围内。在A组和B组中，观察的第一年TRP有所改善；2年后达到C组观察到的值（TRP：A组：0.67±0.1，B组：0.72±0.13，C组：0.76±0.07；P=无显著性差异），而2年后A组的TmPO₄/GFR仍较低（A组：0.78±0.19，B组：0.91±0.25，C组：0.94±0.15；P<.05）。与接受环孢素治疗的受者相比，接受他克莫司治疗的患者肾小管磷重吸收受损的恢复明显更快。基于他克莫司的免疫抑制在2年观察期内导致更好的肾移植功能。
