Sundaram Varun, Abraham Georgi, Fathima Nusrath, Sundaram Vivek, Reddy Yogesh N V, Mathew Milly, Sathiah Vijaiaboobbathi
Department of Nephrology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
Saudi J Kidney Dis Transpl. 2010 Jan;21(1):37-42.
The aim of this study was to evaluate the efficacy of conversion from calcineurin inhibitors (CNI)-based to a rapamycin-based immunosuppressive regimen in renal transplant recipients who had allograft dysfunction, in a South Indian population. We analyzed the results of 75 (19.5%) of the 398 renal transplants performed over a five-year period from 2002 to 2007, who were converted from a CNI-based immunosuppression to rapamycin including patients with chronic allograft dysfunction, chronic allograft injury and malignancy. The data analyzed included serial rapamycin levels, serum creatinine, eGFR by nankivel formula, lipid profile, hemoglobin and serum potassium levels. Statistical analysis was performed using student's t test and the Kaplan Meir survival curve was used to predict probability of survival among patients on rapamycin. The mean age of the study patients was 39.6 + or - 12.2 yrs and there was a male predominance (74.6%). Diabetic nephropathy was the predominant cause (36%) of end-stage renal disease (ESRD). Statistical analysis revealed a significant improvement in GFR of 14.6 mL/min and decrease in potassium by 0.7 mmol/L after initiation of rapamycin. There were no significant differences in terms of lipid profile, platelet count, hemoglobin and urine albumin levels. Rapamycin was discontinued in one patient due to hypokalemic nephropathy and in another patient due to delayed wound healing. To our knowledge, this is the first study to provide information on the conversion from a CNI to rapamycin-based immunosuppression in a cohort of Indian renal transplant recipients. In conclusion, the findings of our study confirm that rapamycin-based immunosuppressive regimen improves renal function and graft survival with minimal side effects, in comparison to CNI-based immunosuppression.
本研究的目的是评估在南印度人群中，将基于钙调神经磷酸酶抑制剂（CNI）的免疫抑制方案转换为基于雷帕霉素的免疫抑制方案，对出现移植肾功能不全的肾移植受者的疗效。我们分析了2002年至2007年五年间进行的398例肾移植中75例（19.5%）的结果，这些患者从基于CNI的免疫抑制转换为雷帕霉素治疗，包括慢性移植肾功能不全、慢性移植肾损伤和恶性肿瘤患者。分析的数据包括雷帕霉素的系列水平、血清肌酐、根据南基韦尔公式计算的估算肾小球滤过率（eGFR）、血脂谱、血红蛋白和血清钾水平。采用学生t检验进行统计分析，并使用Kaplan-Meir生存曲线预测接受雷帕霉素治疗患者的生存概率。研究患者的平均年龄为39.6±12.2岁，男性占优势（74.6%）。糖尿病肾病是终末期肾病（ESRD）的主要原因（36%）。统计分析显示，开始使用雷帕霉素后，肾小球滤过率显著提高14.6 mL/分钟，血钾降低0.7 mmol/L。血脂谱、血小板计数、血红蛋白和尿白蛋白水平无显著差异。1例患者因低钾性肾病停用雷帕霉素，另1例患者因伤口愈合延迟停用。据我们所知，这是第一项提供关于印度肾移植受者队列中从基于CNI转换为基于雷帕霉素的免疫抑制信息的研究。总之，我们的研究结果证实，与基于CNI的免疫抑制相比，基于雷帕霉素的免疫抑制方案能改善肾功能和移植肾存活，且副作用最小。
