肾移植中低剂量与高剂量环孢素诱导方案
Low-dose versus high-dose cyclosporine induction protocols in renal transplantation.
作者信息
Ghafari A, Makhdoomi K, Ahmadpour P, Afshari A T, Fallah M M, Rad P S
机构信息
Department of Internal Medicine, Urmia University of Medical Sciences, Urmia, Iran.
出版信息
Transplant Proc. 2007 May;39(4):1219-22. doi: 10.1016/j.transproceed.2007.03.014.
BACKGROUND
Current immunosuppressive therapies are effective to prevent acute rejection episodes (ARE) and graft loss following renal transplantation. Newer agents now make it possible to develop equally efficacious but better tolerated, less toxic strategies. We compared the efficacy of early low- versus high-dose cyclosporine (CsA) induction therapy in living donor renal transplantation.
METHODS
In this single-center study, 90 consecutive recipients of living donor kidney transplants between November 2002 to October 2003 including 51 females and mean average age of 48.23 years were treated with either CsA (5 mg/kg/d) plus mycophenolae mofetil (MMF; 30 mg/kg/d) and prednisolone (1 mg/kg/d; group 1; n=42); or CsA (8 mg/kg/d) plus MMF (30 mg/kg/d) and prednisolone (1 mg/kg/d; group 2; n=48). The 2 groups were matched with respect to age, sex, underlying renal diseases, pretransplantation dialysis period, number of transplantations, and panel-reactive antibody tests. CsA dose tapering was initiated in the 2 group 3 months after transplantation. At the end of the first year, the CsA dose was 3.5 +/- 0.65 mg/kg in group 1 and 3.4 +/- 0.34 mg/kg in group 2. Prednisolone was tapered within the first 2 months, reaching 10 mg/d in all patients. The MMF dose remained unchanged. The 2 groups were compared with respect to ARE, patient and graft survivals, and clinical outcomes within 2 years after transplantation.
RESULTS
There were no significant differences between the 2 groups with respect to clinical outcomes, including 2-year patient survival (97.62% vs 97.92%; P=.76), 2-year graft survival (80.32% vs 80.41%; P=.82), ARE (47.61% vs 52.08%; P=.09), or length of immediate postsurgical hospital stay, number of readmissions, total hospitalization days, posttransplantation diabetes mellitus, and infectious, cardiovascular, gastrointestinal, and hematologic complications. There was more hypertension (67.5% vs 50.23%; P=.007), hypertriglyceridemia (45.5% vs 32.64%; P=.005), and elevated liver enzymes in group 2 (12.5% vs 7.14%; P=.018).
CONCLUSIONS
Compared with 8 mg/kg CsA induction therapy, the lower doses of CsA were effective, well tolerated, and safe with relatively fewer side effects.
背景
目前的免疫抑制疗法对于预防肾移植术后的急性排斥反应（ARE）和移植物丢失是有效的。新型药物使得开发同等有效但耐受性更好、毒性更低的策略成为可能。我们比较了活体供肾移植中早期低剂量与高剂量环孢素（CsA）诱导治疗的疗效。
方法
在这项单中心研究中，2002年11月至2003年10月期间连续90例活体供肾移植受者（包括51例女性，平均年龄48.23岁）接受了以下治疗：CsA（5mg/kg/天）加霉酚酸酯（MMF；30mg/kg/天）和泼尼松龙（1mg/kg/天；第1组；n = 42）；或CsA（8mg/kg/天）加MMF（30mg/kg/天）和泼尼松龙（1mg/kg/天；第2组；n = 48）。两组在年龄、性别、潜在肾脏疾病、移植前透析时间、移植次数和群体反应性抗体检测方面相匹配。移植后3个月两组开始逐渐减少CsA剂量。在第一年结束时，第1组的CsA剂量为3.5±0.65mg/kg，第2组为3.4±0.34mg/kg。泼尼松龙在最初2个月内逐渐减量，所有患者均减至10mg/天。MMF剂量保持不变。比较两组在ARE、患者和移植物存活率以及移植后2年内的临床结局。
结果
两组在临床结局方面无显著差异，包括2年患者存活率（97.62%对97.92%；P = 0.76）、2年移植物存活率（80.32%对80.41%；P = 0.82）、ARE（47.61%对52.08%；P = 0.09），或术后即刻住院时间、再次入院次数、总住院天数、移植后糖尿病以及感染、心血管、胃肠道和血液系统并发症。第2组高血压（67.5%对50.23%；P = 0.007）、高甘油三酯血症（45.5%对32.64%；P = 0.005）和肝酶升高（12.5%对7.14%；P = 0.018）的发生率更高。
结论
与8mg/kg CsA诱导治疗相比，较低剂量的CsA有效、耐受性良好且安全，副作用相对较少。
Zotero 插件