Department of Nephrology, University Hospital, Heidelberg, Germany.
Transplantation. 2012 Jun 15;93(11):1125-9. doi: 10.1097/TP.0b013e31824f3dae.
Calcineurin inhibitors induce detrimental vascular remodeling, which may be one cause of chronic allograft failure. Real-time contrast-enhanced sonography (CES) is a relatively new technique in providing quantitative information on microvascular tissue perfusion in kidney allografts in more detail. The purpose of the study was to explore whether acute changes of kidney allograft microperfusion due to the administration of cyclosporine A (CsA) and tacrolimus (Tac) can be evidenced using real-time CES.
In an explorative single-center clinical trial, renal parenchymal tissue perfusion of 32 stable kidney allograft recipients was evaluated with CES before and 2 hr after the intake of CsA or Tac. In addition to laboratory and clinical parameters, Doppler indices and estimated glomerular filtration rate were measured.
Although systolic and diastolic blood pressure and color Doppler indices did not significantly differ, there was a significant decrease of renal blood flow 2 hr after the intake of CsA compared with baseline (4.78±2.31 dB/s, 49%, respectively). In contrast, kidney allograft microperfusion was neither significantly reduced in patients receiving CsA paralleled by calcium channel blockers nor significantly reduced in patients receiving Tac. Furthermore, there was a significant correlation between renal blood flow obtained before drug administration and kidney function.
CES revealed a 49% reduction of kidney allograft microperfusion 2 hr after the intake of CsA, which might be abrogated by calcium channel blockers. In comparison to CsA, Tac did not result in a significant decrease of kidney blood flow.
钙调磷酸酶抑制剂可引起有害的血管重构，这可能是慢性移植物失功的一个原因。实时对比增强超声（CES）是一种较新的技术，可更详细地提供肾移植中微血管组织灌注的定量信息。本研究的目的是探讨环孢素 A（CsA）和他克莫司（Tac）给药后肾移植微灌注的急性变化是否可以通过实时 CES 来证实。
在一项探索性的单中心临床试验中，在接受 CsA 或 Tac 摄入前和摄入后 2 小时，用 CES 评估 32 例稳定的肾移植受者的肾实质组织灌注。除了实验室和临床参数外，还测量了多普勒指数和估计的肾小球滤过率。
尽管收缩压和舒张压以及彩色多普勒指数没有显著差异，但与基线相比，CsA 摄入后 2 小时肾血流明显减少（4.78±2.31 dB/s，分别为 49%）。相比之下，在接受 CsA 治疗的同时接受钙通道阻滞剂的患者中，肾移植微灌注没有显著降低，在接受 Tac 的患者中也没有显著降低。此外，在给药前获得的肾血流与肾功能之间存在显著相关性。
CES 显示 CsA 摄入后 2 小时肾移植微灌注减少 49%，钙通道阻滞剂可能会阻断这种减少。与 CsA 相比，Tac 不会导致肾血流量显著减少。
