Nakazawa S, Kishikawa H, Kawamura M, Ueda N, Hirai T, Nishimura K
Department of Renal Transplantation Center, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan.
Department of Renal Transplantation Center, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan.
Transplant Proc. 2014;46(2):411-4. doi: 10.1016/j.transproceed.2013.12.038.
A number of reports have shown that the efficacy of mycophenolate mofetil (MMF) is superior to that of azathioprine (AZP) for long-term kidney allograft survival. We conducted a retrospective single-center study to evaluate renal function more than 2 years after conversion from AZP to MMF in kidney transplant recipients several years after transplantation.
AZP was converted to MMF in 51 recipients at 17.0 ± 0.8 years after kidney transplantation who were followed up for more than 2 years after conversion. Estimated glomerular filtration rate (eGFR) was determined using the Formula of the Japanese Society of Nephrology.
The eGFR was significantly greater at 1 year before conversion (41.72 ± 1.91 mL/min/1.73 m(2)) as compared with the day of conversion (39.04 ± 1.82 mL/min/1.73 m(2); P < .05). After conversion, eGFR plateaued to 39.30 ± 2.01 mL/min/1.73 m(2) at 1 year and 38.24 ± 2.42 mL/min/1.73 m(2) at 2 years after conversion. The average eGFR slopes were -2.96 ± 0.36 mL/min/1.73 m(2) per year for AZP and 1.22 ± 0.10 mL/min/1.73 m(2) per year for MMF (P < .0001). Cyclosporine (CSA) was reduced from 176 ± 9.3 to 165 ± 9.8 mg/d (P = .0394) after the switch, whereas the CSA trough level was increased from 77.3 ± 6.6 to 118 ± 9.8 ng/mL (P = .0017). Furthermore, the daily dose of tacrolimus (TAC) was decreased from 3.5 ± 0.3 to 3.1 ± 0.3 mg/d (P = .0083).
Our findings demonstrated the safety of conversion from AZP to MMF even in the patients who underwent renal transplantation several years prior. In addition, these short-term results indicated the improvement in allograft function following conversion.
多项报告显示，霉酚酸酯（MMF）对肾移植长期存活的疗效优于硫唑嘌呤（AZP）。我们进行了一项回顾性单中心研究，以评估肾移植受者在移植数年之后从AZP转换为MMF超过2年后的肾功能。
51例肾移植受者在移植后17.0±0.8年时将AZP转换为MMF，并在转换后进行了超过2年的随访。采用日本肾脏病学会公式测定估算肾小球滤过率（eGFR）。
转换前1年的eGFR（41.72±1.91 mL/min/1.73 m²）显著高于转换当天（39.04±1.82 mL/min/1.73 m²；P<.05）。转换后，eGFR在转换后1年稳定在39.30±2.01 mL/min/1.73 m²，在转换后2年稳定在38.24±2.42 mL/min/1.73 m²。AZP的平均eGFR斜率为每年-2.96±0.36 mL/min/1.73 m²，MMF为每年1.22±0.10 mL/min/1.73 m²（P<.0001）。转换后，环孢素（CSA）从176±9.3降至165±9.8 mg/d（P=.0394），而CSA谷浓度从77.3±6.6升至118±9.8 ng/mL（P=.0017）。此外，他克莫司（TAC）的每日剂量从3.5±0.3降至3.1±0.3 mg/d（P=.0083）。
我们的研究结果表明，即使是在数年前接受肾移植的患者中，从AZP转换为MMF也是安全的。此外，这些短期结果表明转换后移植肾功能有所改善。
