肝移植后转为西罗莫司为基础的免疫抑制治疗安全且有效：单中心经验。

Switching to sirolimus-based immune suppression after liver transplantation is safe and effective: a single-center experience.

机构信息

Department of Surgery, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom.

出版信息

Transplantation. 2011 Jan 15;91(1):128-32. doi: 10.1097/tp.0b013e3181fe131b.

DOI:10.1097/tp.0b013e3181fe131b

PMID:21452417

Abstract

BACKGROUND

Sirolimus is unlicensed for use in liver transplantation because of concerns over safety, particularly in regard to hepatic artery thrombosis and excess mortality. However, sirolimus offers potential advantages over calcineurin inhibitor-based immunosuppression, relating to its renal sparing and antiproliferative properties.

METHODS

A review was undertaken of 148 liver transplant patients converted to sirolimus over 10 years at a single center.

RESULTS

The main indications for sirolimus were renal impairment and hepatitis C virus fibrosis. One hundred eleven (75%) patients remained on sirolimus after median follow-up of 1006 days. Mean (+/-standard deviation) glomerular filtration rate improved significantly from 59+/-29 mL/min preconversion to 72+/-39 mL/min at censor point (P<0.05). Improvement in glomerular filtration rate was most marked in patients converted for renal impairment. Liver function tests remained stable or improved, particularly in patients transplanted for hepatitis C virus. Side effects attributed to sirolimus occurred in 101 (68%) patients requiring withdrawal in 20 patients (14%). Moderate increases in serum lipids were observed and controlled effectively with statins. The incidence of proteinuria increased postconversion but had no deleterious impact on renal function. No episodes of hepatic artery thrombosis were observed.

CONCLUSIONS

Sirolimus was safe and may improve outcome in selected patients after liver transplantation.

摘要

背景

由于对安全性的担忧，特别是在肝动脉血栓形成和死亡率增加方面，西罗莫司在肝移植中未获得许可。然而，西罗莫司在肾保护和抗增殖特性方面相对于钙调神经磷酸酶抑制剂为基础的免疫抑制具有潜在优势。

方法

在一个中心对 148 例在 10 年内转换为西罗莫司的肝移植患者进行了回顾性研究。

结果

西罗莫司的主要适应证是肾功能损害和丙型肝炎病毒纤维化。在中位随访 1006 天后，111 例（75%）患者仍继续使用西罗莫司。肾小球滤过率从转换前的 59+/-29 mL/min 到截止点的 72+/-39 mL/min 显著改善（P<0.05）。在因肾功能损害而转换的患者中，肾小球滤过率的改善最为明显。肝功能试验保持稳定或改善，特别是在丙型肝炎病毒移植的患者中。101 例（68%）患者发生了与西罗莫司相关的副作用，其中 20 例（14%）需要停药。观察到中等程度的血脂升高，并通过他汀类药物有效控制。转换后蛋白尿的发生率增加，但对肾功能没有不良影响。未观察到肝动脉血栓形成的发生。