Department of Internal Medicine, Division of Nephrology, Dokuz Eylul University Hospital, Izmir, Turkey.
Ren Fail. 2011;33(8):789-94. doi: 10.3109/0886022X.2011.601826. Epub 2011 Jul 25.
In this retrospective study, 83 patients were accepted. Mammalian target of rapamycin (mTOR) group consisting of 37 patients were converted from calcineurin inhibitors (CNI), and the control group included 46 patients (initially CNI-receiving patients). As a control-match of each mTOR inhibitor patient, the succeeding patient with transplantation who continued CNI therapy was chosen. All patients received CNI, MMF, and prednisolone as an immunosuppressive therapy initially. In comparison of two groups, there was no significant difference between sex, donor organ source, donor organ ischemia time, or mismatches. However, mean age between groups was significantly different (mTOR group: 48.3 ± 12, CNI group: 38.6 ± 11, p < 0.001). Decision of conversion to mTOR inhibitors in 30 patients was made by biopsy. The reasons for conversion were determined as CNI nephrotoxicity in 15 patients, chronic allograft nephropathy in 15 patients, malignancy in 6 patients, and renal artery stenosis in 1 patient. Basal glomerular filtration rates (GFRs) were markedly lower in mTOR group than in CNI group (38.8 mL/min vs. 72.7 mL/min). At the end of 48-month follow-ups, GFR increased from 38 mL/min to 54 mL/min in mTOR group; however, it decreased to 53 mL/min from 72 mL/min in CNI group. There was no difference left between the two groups in GFR after 4-year follow-up. Hyperlipidemia was higher in mTOR group. Acute rejection rates were similar. Cytomegalovirus (CMV) disease was more prevalent in CNI group. Graft failure developed due to secondary reasons, causing mortality in both groups. We suggest that conversion to mTOR inhibitors maintains and improves graft functions well.
在这项回顾性研究中，共纳入 83 例患者。其中 mTOR 组 37 例，由钙调磷酸酶抑制剂（CNI）转换而来；对照组包括 46 例（初始接受 CNI 治疗的患者）。作为每个 mTOR 抑制剂患者的对照匹配，选择了随后继续接受 CNI 治疗的移植患者。所有患者最初均接受 CNI、MMF 和泼尼松龙作为免疫抑制治疗。在两组患者的比较中，两组间的性别、供体器官来源、供体器官缺血时间或错配均无显著差异。然而，两组间的平均年龄存在显著差异（mTOR 组：48.3±12，CNI 组：38.6±11，p＜0.001）。30 例患者转换为 mTOR 抑制剂的决定是通过活检做出的。转换的原因是 15 例患者发生 CNI 肾毒性、15 例患者发生慢性移植肾肾病、6 例患者发生恶性肿瘤和 1 例患者发生肾动脉狭窄。mTOR 组的基础肾小球滤过率（GFR）明显低于 CNI 组（38.8mL/min 比 72.7mL/min）。在 48 个月的随访结束时，mTOR 组的 GFR 从 38mL/min 增加到 54mL/min；而 CNI 组的 GFR 从 72mL/min 下降至 53mL/min。在 4 年随访后，两组间的 GFR 无差异。mTOR 组的高脂血症发生率较高。急性排斥反应发生率相似。CMV 病在 CNI 组更为常见。由于继发性原因导致移植物失功，两组均出现死亡。我们认为，转换为 mTOR 抑制剂可很好地维持和改善移植物功能。
