Niel O R P, Berthoux F, Albano L, Dahan P, Aoudia R, Gugenheim J, Cassuto E
Service de Transplantation Rénale, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, A2 UMC, 30 avenue de la voie romaine, 06000 Nice, France.
Transplant Proc. 2009 Oct;41(8):3329-32. doi: 10.1016/j.transproceed.2009.09.034.
The calcineurin inhibitors (CNI) cyclosporine micro emulsion (CyA-ME) and tacrolimus (Tac) both display renal and vascular toxicities. We undertook a single-center retrospective study among 149 surviving liver transplant recipients. The primary outcome was kidney function over 10 years posttransplant, evaluating the glomerular filtration rate (GFR) by the abbreviated Modification of Diet in Renal Disease formula with subsequent Kidney Disease Outcomes Quality Initiative staging. The secondary outcomes included correlations between CNI trough levels (C0), GFR, and items of cardiovascular toxicity. At 1 and 5 years, the mean GFRs were 74.2 and 76.9 mL/min/1.73 m(2) under Tac versus 62.8 and 66.0 mL/min/1.73 m(2) under CyA-ME (P < .001). The mean value in favor of Tac was + 10 mL/min/1.73 m(2). Distribution of GFR stages showed more Tac patients at stage 1 or 2 and more at stage 4 or 5 under CyA-ME. There was no significant correlation between CNI-C0 and GFR. Switches between CNI or to mycophenolate mofetil did not show any significant GFR improvement. Patients under CyA-ME displayed significantly higher blood pressures with 3 requiring dialysis versus none under Tac. In conclusion, we observed that liver transplant patients under Tac maintained significantly better renal function with less progression to dialysis as compared with CyA-ME, indicating a lower renal and vascular (lower BP) toxicity.
钙调神经磷酸酶抑制剂（CNI）环孢素微乳剂（CyA-ME）和他克莫司（Tac）均表现出肾脏和血管毒性。我们对149例存活的肝移植受者进行了一项单中心回顾性研究。主要结局是移植后10年的肾功能，采用简化的肾脏疾病饮食改良公式评估肾小球滤过率（GFR），随后进行肾脏疾病改善全球预后分期。次要结局包括CNI谷浓度（C0）、GFR与心血管毒性指标之间的相关性。在1年和5年时，Tac组的平均GFR分别为74.2和76.9 mL/min/1.73 m²，而CyA-ME组分别为62.8和66.0 mL/min/1.73 m²（P <.001）。Tac组的平均优势值为+10 mL/min/1.73 m²。GFR分期分布显示，Tac组处于1期或2期的患者更多，而CyA-ME组处于4期或5期的患者更多。CNI-C0与GFR之间无显著相关性。在CNI之间切换或改用霉酚酸酯未显示GFR有任何显著改善。CyA-ME组患者的血压显著更高，有3例需要透析，而Tac组无此情况。总之，我们观察到，与CyA-ME相比，接受Tac治疗的肝移植患者肾功能维持得明显更好，进展至透析的情况更少，表明其肾脏和血管毒性（较低的血压）更低。
