Yoshimura N, Ushigome H, Nobori S, Suzuki T, Sakai K, Koshino K, Okajima H, Okamoto M
Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Transplant Proc. 2013 May;45(4):1472-5. doi: 10.1016/j.transproceed.2013.01.055.
Mizoribine (MZR) at 3 mg/kg/d shows less potent immunosuppressive effects, but high-dose MZR (6 mg/kg/d) was effective and safe in a 2-year study in conjunction with a regimen of cyclosporine (CsA), basiliximab, and corticosteroids.
We compared 40 living-related kidney recipients administered MZR (6 mg/kg/d), CsA (7 mg/kg/d), prednisolone (maintenance dose 10 mg/d), and basiliximab (20 mg/body) with control group (n = 38) treated with CsA, mycophenolate mofetil (MMF; 25 mg/kg/d), basiliximab, and corticosteroids.
The 4-year graft survival rates for the MZR vs MMF groups were 92.5% vs 94.7%, respectively, with serum creatinine levels of 1.66 ± 1.0 mg/dL vs 1.41 ± 0.42 mg/dL at 3 years, and 1.72 ± 1.16 mg/dL vs 1.56 ± 1.26 mg/dL at 4 years. There was no significant difference in serum creatinine levels between the 2 groups. The MZR group demonstrated a significantly higher rate of elevated serum uric acid values (29.7%). The numbers of patients treated with allopurinol at 4 years were 11/37 (29.7%) for MZR vs 2/36 (5.6%) for the MMF subjects (P < .05). Mean serum uric acid levels of the MZR vs MMF group at 4 years were 7.1 ± 1.9 mg/dL vs 7.0 ± 1.6 mg/dL, respectively (NS). There was no significant difference between the 2 groups regarding bone marrow suppression or liver dysfunction. Severe cytomegalovirus infection was not observed at 3 and 4 years in either group. There were no severe gastrointestinal symptoms among the MZR or the MMF group at 3 or 4 years.
The combination of high-dose MZR with CsA, basiliximab, and corticosteroids displayed excellent results over a 4-year follow-up.
米唑立宾（MZR）以3毫克/千克/天的剂量显示出较弱的免疫抑制作用，但在一项为期2年的研究中，高剂量米唑立宾（6毫克/千克/天）与环孢素（CsA）、巴利昔单抗和皮质类固醇联合使用是有效且安全的。
我们将40例接受米唑立宾（6毫克/千克/天）、环孢素（7毫克/千克/天）、泼尼松龙（维持剂量10毫克/天）和巴利昔单抗（20毫克/人）治疗的亲属活体肾移植受者与接受环孢素、霉酚酸酯（MMF；25毫克/千克/天）、巴利昔单抗和皮质类固醇治疗的对照组（n = 38）进行比较。
米唑立宾组与霉酚酸酯组的4年移植肾存活率分别为92.5%和94.7%，3年时血清肌酐水平分别为1.66±1.0毫克/分升和1.41±0.42毫克/分升，4年时分别为1.72±1.16毫克/分升和1.56±1.26毫克/分升。两组血清肌酐水平无显著差异。米唑立宾组血清尿酸值升高的发生率显著更高（29.7%）。4年时接受别嘌醇治疗的患者数量，米唑立宾组为11/37（29.7%），霉酚酸酯组为2/36（5.6%）（P <.05）。4年时米唑立宾组与霉酚酸酯组的平均血清尿酸水平分别为7.1±1.9毫克/分升和7.0±1.6毫克/分升（无显著性差异）。两组在骨髓抑制或肝功能障碍方面无显著差异。两组在3年和4年时均未观察到严重的巨细胞病毒感染。米唑立宾组和霉酚酸酯组在3年或4年时均无严重的胃肠道症状。
在4年的随访中，高剂量米唑立宾与环孢素、巴利昔单抗和皮质类固醇联合使用显示出优异的结果。
