Bäckman L, Reisaeter A Varberg, Wramner L, Ericzon B-G, Salmela K, Brattström C
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Clin Transplant. 2006 May-Jun;20(3):336-9. doi: 10.1111/j.1399-0012.2006.00489.x.
Two Six-month pilot studies were conducted in renal (n = 17) or liver (n = 15) transplant recipients to evaluate renal function after conversion from calcineurin inhibitor (CI)- to sirolimus (SRL)-based immunosuppression. After an SRL loading dose, doses were individualized to achieve whole blood trough levels of 10-22 ng/mL. Overall, serum creatinine did not change from baseline to six months post-conversion but an improvement from 219.9 to 201.4 micromol/L at three months was noted in renal transplant recipients (p < 0.05). Another finding was a numerical increase in the mean glomerular filtration rate (GFR) from 26.8 to 33.2 mL/min/1.73 m(2) at six months among liver transplant recipients (NS). All patients survived and all grafts were functioning at the end of the study. In conclusion, renal function remained stable, with a tendency towards improvement, after abrupt conversion from CI- to SRL-based therapy in renal or liver transplant recipients with moderate renal insufficiency.
开展了两项为期六个月的试点研究,对象为肾移植受者(n = 17)或肝移植受者(n = 15),以评估从基于钙调神经磷酸酶抑制剂(CI)转换为基于西罗莫司(SRL)的免疫抑制治疗后的肾功能。给予SRL负荷剂量后,根据个体情况调整剂量,以使全血谷浓度达到10 - 22 ng/mL。总体而言,从转换前到转换后六个月,血清肌酐水平未发生变化,但肾移植受者在转换后三个月时血清肌酐水平从219.9 μmol/L改善至201.4 μmol/L(p < 0.05)。另一项发现是,肝移植受者在六个月时平均肾小球滤过率(GFR)从26.8 mL/min/1.73 m² 升至33.2 mL/min/1.73 m²(无统计学意义)。所有患者均存活,且在研究结束时所有移植物均功能良好。总之,对于中度肾功能不全的肾移植或肝移植受者,从基于CI的治疗突然转换为基于SRL的治疗后,肾功能保持稳定且有改善趋势。