Sessa A, Esposito A, Iavicoli G, Lettieri E, Ragosta G, Rossano R, Capuano M
Day Hospital Post-trapianto Rene, UOC Nefrologia e Dialisi, Napoli, Italy.
Transplant Proc. 2012 Sep;44(7):1901-6. doi: 10.1016/j.transproceed.2012.05.060.
Cardiovascular (CV) diseases are the leading cause of death after renal transplantation. Renal transplant patients present CV risk factors that correlate with renal function and the use of immunosuppressive drugs. Noncompliance with immunosuppressive therapy after organ transplantation increases the incidence of rejection, graft loss, and patient death. A simple posology regimen is the best way to promote compliance with prescribed therapy. To meet this need, a new formulation of tacrolimus that is suitable for once-daily administration, is now available on the market: prolonged-release tacrolimus (Fkpr). We analyzed changes in CV risk factors observed in renal transplant patients after transition from standard tacrolimus (Fk) to Fkpr and the rate of patients with the investigated parameters within the normal ranges before and after conversion. The study enrolled 40 Caucasian renal transplant patients (26 men and 14 women) who were being followed at our posttransplantation day hospital clinics. After a varying time interval after transplantation, patients on treatment with tacrolimus, mycophenolate + mofetil (MMF), and steroid entered a 12-month observation period. Thereafter, they were switched to Fkpr, also in association with MMF and steroid, and were observed for a further 12-month period. The following parameters were tested in all patients: creatinine, creatinine clearance, insulin resistance, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, uric acid, homocysteine, and urine magnesium. The switch from Fk to Fkpr showed an improvement of the parameters investigated. Moreover, the proportion of patients with normal laboratory values after the transition from Fk to Fkpr was noted either to increase or to remain stable at the improved levels observed during therapy with Fk. Immunosuppressive treatment with Fkpr represents an even better option than Fk for renal transplant patients, because by reducing CV risk factors it favorably affects the long-term outcomes for graft and patient.
心血管（CV）疾病是肾移植后主要的死亡原因。肾移植患者存在与肾功能及免疫抑制药物使用相关的CV危险因素。器官移植后不遵守免疫抑制治疗会增加排斥反应、移植肾丢失及患者死亡的发生率。简单的用药方案是促进患者遵守规定治疗的最佳方式。为满足这一需求，一种适合每日一次给药的他克莫司新制剂现已上市：缓释他克莫司（Fkpr）。我们分析了肾移植患者从标准他克莫司（Fk）转换为Fkpr后观察到的CV危险因素变化，以及转换前后各项研究参数处于正常范围的患者比例。该研究纳入了40例在我们移植后日间医院诊所接受随访的白种人肾移植患者（26例男性和14例女性）。在移植后的不同时间间隔后，接受他克莫司、霉酚酸酯+吗替麦考酚酯（MMF）和类固醇治疗的患者进入为期12个月的观察期。此后，他们也联合MMF和类固醇改用Fkpr，并再观察12个月。对所有患者检测了以下参数：肌酐、肌酐清除率、胰岛素抵抗、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、尿酸、同型半胱氨酸和尿镁。从Fk转换为Fkpr显示所研究的参数有所改善。此外，从Fk转换为Fkpr后实验室值正常的患者比例在Fk治疗期间观察到的改善水平上要么增加，要么保持稳定。对于肾移植患者，Fkpr免疫抑制治疗比Fk是更好的选择，因为通过降低CV危险因素，它对移植肾和患者的长期预后有有利影响。
