Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Clin Transplant. 2012 Jan-Feb;26(1):42-9. doi: 10.1111/j.1399-0012.2011.01407.x. Epub 2011 Feb 9.
Calcineurin inhibitor (CNI)-associated renal insufficiency is common after cardiac transplantation (CTX); however, the addition of sirolimus allows for CNI dose reduction and this strategy may limit CNI renal toxicity. This study examines the long-term effects of such a strategy.
Patients from a single center who had CTX from 1990 to 2007 and who were converted to sirolimus and a dose-reduced CNI were compared to group-matched controls maintained on CNI and an antiproliferative agent.
One hundred and fifty-five patients (79 sirolimus and 76 controls) were included and had similar baseline characteristics. Sirolimus was started a mean of 1429 d post-CTX and maintained for a mean of 823 d. Reason for conversion to sirolimus was renal insufficiency (34%), vasculopathy (29%), recurrent rejection (19%), and other (18%). The eGFR was not different between groups at baseline (44.7 mL/min/1.73 m(2) vs. 46.0, p = 0.64) or at any point during follow-up: 90 d, 180 d, 1 yr, 2 yr, and 3 yr. conclusion: Patients converted to a regimen of sirolimus and a dosed-reduced CNI have stable renal function over the following three yr, but do not have an improvement in renal outcomes compared to patients maintained on full dose CNI.
钙调磷酸酶抑制剂（CNI）相关的肾功能不全是心脏移植（CTX）后常见的；然而，西罗莫司的加入允许减少 CNI 剂量，这种策略可能会限制 CNI 的肾毒性。本研究检查了这种策略的长期效果。
本研究来自一个中心的患者，他们在 1990 年至 2007 年期间进行了 CTX，并转换为西罗莫司和减少剂量的 CNI，并与接受 CNI 和抗增殖剂治疗的匹配对照组进行比较。
共有 155 名患者（79 名西罗莫司和 76 名对照组）被纳入，且具有相似的基线特征。西罗莫司开始使用的平均时间为 CTX 后 1429 天，维持时间的平均时间为 823 天。转换为西罗莫司的原因是肾功能不全（34%）、血管病变（29%）、复发性排斥反应（19%）和其他（18%）。基线时两组的 eGFR 没有差异（44.7 ml/min/1.73 m(2)与 46.0，p=0.64）或在随访期间的任何时间点：90 天、180 天、1 年、2 年和 3 年。结论：转换为西罗莫司和减少剂量的 CNI 方案的患者在接下来的 3 年中肾功能稳定，但与接受全剂量 CNI 治疗的患者相比，肾功能没有改善。
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