Department of Nephrology and Renal Transplantation, Hospital Clínic, Barcelona, Spain.
Transplantation. 2013 Sep 15;96(5):480-6. doi: 10.1097/TP.0b013e31829a9231.
Immunosuppression after kidney transplantation has been associated with weight gain. The aim was to evaluate if sirolimus (SRL) had a different effect on weight gain than calcineurin inhibitor (CNI).
Data on body weight in different patient populations were analyzed at several time points: (a) SRL (CNI-free) versus cyclosporine A (CsA) treatment de novo, (b) CsA+SRL versus CsA (SRL-free) treatment de novo, (c) SRL+tacrolimus elimination at 3 months versus SRL+mycophenolate mofetil versus tacrolimus+mycophenolate mofetil de novo, and (d) conversion from CNI to SRL versus CNI in maintenance patients.
Patients were analyzed from de novo transplantation trials (n=1863) and from the conversion study (n=742). At baseline, weight in the SRL-containing and SRL-free treatment arms was not different, but weight gain was significantly less pronounced in SRL in de novo treatment (group 1: 2.8±4.6 vs. 6.2±6.6 kg every 2 years, P=0.020; group 2: 6.1±9.5 vs. 9.6±9.1 kg every 2 years, P<0.001; and group 3: 3.7±7.0 vs. 3.5±6.2 vs. 5.9±9.0 kg every 1 year, P=0.042). In the conversion study, patients lost weight in the SRL arm and gained weight in the CNI arm (-1.0±6.0 vs. +1.0±5.1 kg every 2 years; P<0.001).
SRL treatment is associated with less weight gain de novo as well as in late conversion.
肾移植后免疫抑制与体重增加有关。本研究旨在评估西罗莫司（SRL）与钙调磷酸酶抑制剂（CNI）相比，对体重增加是否有不同的影响。
在几个时间点分析了不同患者人群的体重数据：（a）SRL（无 CNI）与环孢素 A（CsA）初治，（b）CsA+SRL 与 CsA（无 SRL）初治，（c）SRL+他克莫司 3 个月时消除与 SRL+霉酚酸酯 vs. 他克莫司+霉酚酸酯初治，以及（d）从 CNI 转换为 SRL 与维持治疗中的 CNI。
对初治移植试验（n=1863）和转换研究（n=742）的患者进行了分析。在基线时，SRL 组和 SRL 无治疗组的体重没有差异，但 SRL 初治组体重增加不明显（组 1：2.8±4.6 与 6.2±6.6 kg，每 2 年；P=0.020；组 2：6.1±9.5 与 9.6±9.1 kg，每 2 年；P<0.001；组 3：3.7±7.0 与 3.5±6.2 与 5.9±9.0 kg，每年；P=0.042）。在转换研究中，SRL 组患者体重减轻，CNI 组体重增加（-1.0±6.0 与 +1.0±5.1 kg，每 2 年；P<0.001）。
SRL 初治和晚期转换均与体重增加减少相关。
