Cardinal H, Froidure A, Dandavino R, Daloze P, Hébert M J, Colette S, Boucher A
Nephrology Department, Centre Hospitalier de l'Université de Montréal, Pavillon St-Luc, 1058 rue St-Denis, Montréal H2X 3J4, Canada.
Transplant Proc. 2009 Oct;41(8):3308-10. doi: 10.1016/j.transproceed.2009.08.049.
Replacing a calcineurin inhibitor (CNI) with sirolimus (SRL) may preserve kidney graft function. However, at the present time, only short follow-up after conversion is available. The aim of this study was to assess whether conversion from a CNI-based to an SRL-based maintenance regimen was safe and effective.
We performed a retrospective cohort study among kidney graft patients whose CNI was withdrawn to be replaced by SRL. Two-tailed paired t tests were used to compare glomerular filtration rates (GFRs) and proteinuria levels before and up to 2 years after conversion. We used linear regression to determine the factors associated with changes in renal function after conversion.
The 193 study subjects had a mean GFR at conversion of 41 +/- 16 mL/min/1.73 m(2) a median proteinuria level of 0 g/L (interquartile range = 0-0.15). After conversion, the GFR was stable: at 1 year, the change was -0.34 mL/min/1.73 m(2) (95% confidence interval [CI] = -2.71, 2.03) and at 2 years, -0.96 mL/min/1.73 m(2) (95% CI = 4.26, 2.34). There was a small but significant increase in dipstick proteinuria at 1 year of +0.5 g/L, (95% CI = 0.20, 0.75). On multivariate analysis, proteinuria > or = 1 g/L at the time of conversion was the only predictor of deteriorating GFR at 1 year (beta: -7.91 mL/min/1.73 m(2); 95% CI = -14.10, -1.70). SRL had to be discontinued in 31% of patients.
Conversion from CNI to SRL resulted in stable graft function at 2 years and in a slight increase in proteinuria. Despite the relatively high reconversion rate, this strategy offers a reasonable alternative to CNIs for most patients.
用西罗莫司（SRL）替代钙调神经磷酸酶抑制剂（CNI）可能会保留肾移植功能。然而，目前转换治疗后的随访时间较短。本研究的目的是评估从基于CNI的维持治疗方案转换为基于SRL的维持治疗方案是否安全有效。
我们对停用CNI并用SRL替代的肾移植患者进行了一项回顾性队列研究。采用双尾配对t检验比较转换前及转换后2年内的肾小球滤过率（GFR）和蛋白尿水平。我们使用线性回归确定转换后与肾功能变化相关的因素。
193名研究对象转换时的平均GFR为41±16 mL/min/1.73 m²，蛋白尿中位数水平为0 g/L（四分位间距=0 - 0.15）。转换后，GFR保持稳定：1年时，变化为-0.34 mL/min/1.73 m²（95%置信区间[CI]=-2.71, 2.03），2年时为-0.96 mL/min/1.73 m²（95% CI = 4.26, 2.34）。1年时尿试纸法检测的蛋白尿有小幅但显著增加，增加了0.5 g/L（95% CI = 0.20, 0.75）。多因素分析显示，转换时蛋白尿≥1 g/L是1年时GFR恶化的唯一预测因素（β：-7.91 mL/min/1.73 m²；95% CI = -14.10, -1.70）。31%的患者不得不停用SRL。
从CNI转换为SRL可使移植肾功能在2年内保持稳定，蛋白尿略有增加。尽管再转换率相对较高，但该策略为大多数患者提供了一种合理的CNI替代方案。
