Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Clin Transplant. 2009 Nov-Dec;23(6):887-96. doi: 10.1111/j.1399-0012.2009.01040.x. Epub 2009 Jul 28.
The long-term use of calcineurin inhibitors (CNI) leads to renal dysfunction in many liver transplant (LT) recipients. The purpose of this analysis is to evaluate renal function in patients converted from CNI to sirolimus (SRL). From May 2002-November 2006, 137 LT were performed in 125 patients, 72 of which were converted to SRL. Evaluation of SRL conversion was stratified by early conversion (<90 d from LT) (EC) vs. late conversion (LC). Renal function was evaluated using the six-point modification of diet in renal disease formula (estimated glomerular filtration rate [eGFR]). Forty-two patients on SRL and 40 on CNI had at least three months of follow-up and are included in the eGFR evaluation. At all time points after conversion, the EC group demonstrated a significantly higher mean eGFR than those in the LC group. A significant improvement in eGFR was seen within the EC group when comparing eGFR at time of conversion to eGFR at three, six, nine, and 12 months after conversion and last follow-up. The only improvement in the LC group was from conversion to the three-month time point. We conclude that EC to SRL results in a profound improvement in eGFR that begins at three months and is sustained beyond one yr.
钙调磷酸酶抑制剂（CNI）的长期使用会导致许多肝移植（LT）受者肾功能障碍。本分析的目的是评估从 CNI 转换为西罗莫司（SRL）的患者的肾功能。从 2002 年 5 月至 2006 年 11 月，125 例患者进行了 137 例 LT，其中 72 例转换为 SRL。通过早期转换（LT 后<90 d）（EC）与晚期转换（LC）对 SRL 转换进行分层评估。使用肾脏病饮食改良公式（估计肾小球滤过率[eGFR]）评估 SRL 转换后肾功能。42 例 SRL 患者和 40 例 CNI 患者至少随访 3 个月，纳入 eGFR 评估。在转换后的所有时间点，EC 组的平均 eGFR 均显著高于 LC 组。与转换时的 eGFR 相比，EC 组在转换后 3、6、9 和 12 个月以及最后一次随访时的 eGFR 显著升高。LC 组唯一的改善是从转换到 3 个月的时间点。我们得出结论，EC 至 SRL 可显著改善 eGFR，这种改善始于 3 个月，并持续超过 1 年。
