肾移植受者从他克莫司/西罗莫司转换为他克莫司/霉酚酸酯后肾功能改善。

Improved renal function after conversion from tacrolimus/sirolimus to tacrolimus/mycophenolate mofetil in kidney transplant recipients.

作者信息

Augustine Joshua J, Chang Peter C, Knauss Thomas C, Aeder Mark I, Bodziak Kenneth A, Schulak James A, Hricik Donald E

机构信息

Division of Nephrology, University Hospitals of Cleveland, OH 44106, USA.

出版信息

Transplantation. 2006 Apr 15;81(7):1004-9. doi: 10.1097/01.tp.0000202880.78509.b4.

DOI:10.1097/01.tp.0000202880.78509.b4

PMID:16612276

Abstract

BACKGROUND

There is limited data on the potential nephrotoxicity of sirolimus (SRL) and tacrolimus (TAC) in combination.

METHODS

We reviewed the course of 97 kidney transplant patients treated with SRL and reduced-dose TAC. Conversion from SRL to mycophenolate mofetil (MMF) was prescribed in a minority (n = 19) for various nonrenal side effects. We compared outcomes of converted patients to those remaining on TAC/SRL (n = 78).

RESULTS

TAC levels were increased in converters (P = 0.009). Rejection rates were similar between groups over 18 months (21% vs. 16%, p = ns). Serum creatinine (Cr) and MDRD glomerular filtration rate (GFR) were similar between groups at nadir and six-months, but at 18 months the percent change from six-month Cr was +17% in non-converters vs. -10% in converters (P = 0.004 for the difference). The difference in GFR between groups at 18 months was also significant (P = 0.01). By multivariate analysis, only conversion to MMF was associated with a greater percent change in Cr from 6 to 18 months (P = 0.015). Conversion to MMF also correlated with higher GFR at 18 months independent of rejection, delayed graft function, and ethnicity.

CONCLUSIONS

Conversion from TAC/SRL to TAC/MMF led to improved renal function despite increased TAC exposure after conversion.

摘要

背景

关于西罗莫司（SRL）和他克莫司（TAC）联合使用时潜在肾毒性的数据有限。

方法

我们回顾了97例接受SRL和减量TAC治疗的肾移植患者的病程。少数患者（n = 19）因各种非肾性副作用而从SRL转换为霉酚酸酯（MMF）。我们将转换患者的结果与继续使用TAC/SRL的患者（n = 78）进行了比较。

结果

转换患者的TAC水平升高（P = 0.009）。两组在18个月内的排斥反应发生率相似（21%对16%，p = 无显著差异）。血清肌酐（Cr）和MDRD肾小球滤过率（GFR）在最低点和6个月时两组相似，但在18个月时，非转换组从6个月时的Cr变化百分比为+17%，而转换组为-10%（差异P = 0.004）。两组在18个月时的GFR差异也具有统计学意义（P = 0.01）。通过多变量分析，只有转换为MMF与6至18个月时Cr的更大变化百分比相关（P = 0.015）。转换为MMF还与18个月时更高的GFR相关，且与排斥反应、移植肾功能延迟和种族无关。