Campsen Jeffrey, Zimmerman Michael A, Mandell Susan, Kaplan Maria, Kam Igal
Division of Transplant Surgery, Department of Surgery, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.
J Transplant. 2011;2011:913094. doi: 10.1155/2011/913094. Epub 2011 Mar 15.
Some studies suggest that Sirolimus (SRL) is associated with an increased risk of death in liver transplant recipients compared to treatment with calcineurin inhibitors (CNIs). We compared patients who received SRL or CNI in the first year after liver transplant. Our database included 688 patients who received a liver transplant. The patients were divided into groups. (1) CNI + MPS (mycophenolate sodium) at time of discharge. (2) CNI + MPS at time of discharge; SRL was added within the first 6 months and continued through the first year. (3) CNI + MPS at time of discharge; SRL was added within the first 6 months and discontinued before the first year. (4) SRL as primary immunosuppression. (5) SRL as primary immunosuppression and discontinued before the first year. We used mortality and graft loss as the primary measures of outcome. We also quantified renal function using the change in glomerular filtration rate (GFR), the presence of biopsy proven acute cellular reject (ACR), and steroid-resistant rejection (SRR). There were no significant differences in mortality or graft loss. There was no difference in patient or graft survival. Patients that received SRL as primary immunosuppression had 50% less rejection compared to controls.
一些研究表明，与使用钙调神经磷酸酶抑制剂（CNIs）治疗相比，西罗莫司（SRL）与肝移植受者死亡风险增加有关。我们比较了肝移植后第一年接受SRL或CNI治疗的患者。我们的数据库包括688例接受肝移植的患者。这些患者被分为几组。（1）出院时使用CNI + 麦考酚钠（MPS）。（2）出院时使用CNI + MPS；在最初6个月内加用SRL并持续至第一年。（3）出院时使用CNI + MPS；在最初6个月内加用SRL并在第一年前停用。（4）以SRL作为主要免疫抑制剂。（5）以SRL作为主要免疫抑制剂并在第一年前停用。我们将死亡率和移植物丢失作为主要结局指标。我们还使用肾小球滤过率（GFR）的变化、活检证实的急性细胞排斥反应（ACR）的存在以及类固醇抵抗性排斥反应（SRR）来量化肾功能。在死亡率或移植物丢失方面没有显著差异。患者或移植物存活率没有差异。与对照组相比，以SRL作为主要免疫抑制剂的患者排斥反应减少50%。
