Basso Maria-Sole, Subramaniam Pushpa, Tredger Mike, Verma Anita, Heaton Nigel, Rela Mohamed, Mieli-Vergani Giorgina, Dhawan Anil
Paediatric Liver, GI and Nutrition Centre, Institute of Liver Studies, King's College Hospital, London, UK.
Pediatr Transplant. 2011 Nov;15(7):722-7. doi: 10.1111/j.1399-3046.2011.01560.x.
CNI have improved the outcome of LT. However, their inherent potential to nephrotoxic and sometimes-inadequate immunosuppressive effect has lead to the usage of newer drugs like SRL. Aim of this study was to review children who received SRL. Thirty-seven (20 women) children post-LT, median age 10.4 yr (0.8-17.4) with a minimum follow-up of six months comprised the study group. Indications for SRL were biopsy-proven resistant acute allograft rejection (n = 12), early CR (n = 12), and CNI-induced nephropathy with MMF intolerance (n = 11). In two patients, the indication was the recurrence of BSEP disease in the allograft. In patients with acute rejection, AST normalized in 10/12 patients. In patients with CR, AST normalized in 6/12 patients. Those with renal impairment showed improvement in their creatinine levels from a mean baseline of 99-56.7 μm (p = 0.03) and their mean cystatin C was 1.02 after SRL. Side effects leading to discontinuation of SRL were seen in three patients. SRL was effective in rescuing patients with acute and chronic allograft rejection and improving renal function in CNI-induced nephropathy group.
钙调神经磷酸酶抑制剂（CNI）改善了肝移植（LT）的预后。然而，其固有的肾毒性潜力以及有时不足的免疫抑制作用导致了西罗莫司（SRL）等新药的使用。本研究的目的是回顾接受SRL治疗的儿童。研究组包括37名（20名女性）肝移植术后儿童，中位年龄10.4岁（0.8 - 17.4岁），最短随访6个月。使用SRL的指征为活检证实的移植肾急性排斥反应抵抗（n = 12）、早期慢性排斥反应（n = 12）以及CNI诱导的肾病伴霉酚酸酯不耐受（n = 11）。在2例患者中，指征为移植肾中胆汁盐输出泵（BSEP）疾病复发。急性排斥反应患者中，10/12例患者的谷草转氨酶（AST）恢复正常。慢性排斥反应患者中，6/12例患者的AST恢复正常。肾功能损害患者的肌酐水平从平均基线99 - 56.7 μmol/L有所改善（p = 0.03），使用SRL后其平均胱抑素C为1.02。3例患者出现导致停用SRL的副作用。SRL在挽救急性和慢性移植肾排斥反应患者以及改善CNI诱导的肾病组肾功能方面有效。
