Chen G-D, Liu X-C, Shi L, Qiu J, Wang C-X, Fei J-G, Li J, Huang G, Chen L-Z
Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Transplant Proc. 2013 May;45(4):1648-50. doi: 10.1016/j.transproceed.2013.01.099.
Recipients of living donor kidney transplantations from older donors often experience a lower glomerular filtration rate (GFR) than those from young donors. Calcineurin inhibitors (CNI) may cause nephrotoxicity, especially in recipients of older donor organs. The aim of this study was to investigate whether CNI withdrawal and conversion to rapamycin improved graft function among transplantation recipients of living donor kidneys from older donors.
We collected 83 living donor kidney transplantations using donors aged >50 years from January 2004 to December 2009, including 25 who underwent conversion to rapamycin at the end of 3 months, while 58 cases were maintained on CNI. Baseline characteristics, complications, and graft functions were compared between the groups.
Donor age, recipient age, body weight, human leukocyte antigen mismatch, delayed graft function, acute rejection rate, serum creatinine, and estimated GFR were comparable between the 2 groups at the end of 3 months. The 1-year serum creatinine were 111.8 ± 25.5 μmol/L in CNI withdrawal versus 132.5 ± 35.9 μmol/L in the CNI-maintained group (P = .013) with 1-year estimated GFR of 86.9 ± 8.2 mL/min versus 77.4 ± 7.2 mL/min and 3-year estimated GFR of 76.1 ± 7.8 mL/min versus 67.0 ± 6.4 mL/min, respectively (both P < .001). The rates of acute rejection were 24% versus 22.4%, and chronic rejection, 4.0% versus 10.3% respectively (P > .05). One CNI withdrawal patient (4.0%) lost the graft function while 4 (6.9%) did so in the CNI-maintained group (P > .05). Logistic multivariate regression showed that maintained CNI usage, acute rejection episodes, and female donors to male recipients were independent risk factors for abnormal 1-year serum creatinine levels (P < .05).
CNI withdrawal with conversion to rapamycin improved graft function in living donor kidney transplantations from older donors.
与接受年轻供体肾脏活体移植的受者相比，接受老年供体肾脏活体移植的受者肾小球滤过率（GFR）通常较低。钙调神经磷酸酶抑制剂（CNI）可能会导致肾毒性，尤其是在接受老年供体器官移植的受者中。本研究的目的是调查停用CNI并转换为雷帕霉素是否能改善接受老年供体肾脏活体移植受者的移植肾功能。
我们收集了2004年1月至2009年12月期间83例使用年龄大于50岁供体的肾脏活体移植病例，其中25例在3个月末转换为雷帕霉素治疗，58例继续使用CNI治疗。比较两组的基线特征、并发症和移植肾功能。
3个月末时，两组之间的供体年龄、受者年龄、体重、人类白细胞抗原错配、移植肾功能延迟恢复、急性排斥反应发生率、血清肌酐水平和估算的GFR相当。停用CNI组1年时血清肌酐水平为111.8±25.5μmol/L，而继续使用CNI组为132.5±35.9μmol/L（P = 0.013）；1年估算GFR分别为86.9±8.2 mL/min和77.4±7.2 mL/min，3年估算GFR分别为76.1±7.8 mL/min和67.0±6.4 mL/min（均P < 0.001）。急性排斥反应发生率分别为24%和22.4%，慢性排斥反应发生率分别为4.0%和10.3%（P > 0.05）。1例停用CNI的患者（4.0%）移植肾功能丧失，而继续使用CNI组有4例（6.9%）移植肾功能丧失（P > 0.05）。多因素logistic回归分析显示，继续使用CNI、急性排斥反应发作以及女性供体对男性受者是1年时血清肌酐水平异常的独立危险因素（P < 0.05）。
停用CNI并转换为雷帕霉素可改善老年供体肾脏活体移植的移植肾功能。
