Araújo N C, Sampaio Gonçalves de Lucena S B, da Silveira Rioja S
Division of Nephrology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Division of Hematology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Transplant Proc. 2014 Jun;46(5):1319-23. doi: 10.1016/j.transproceed.2014.03.011.
Based on evidence available in the literature, rapamycin, a mammalian target of rapamycin (mTOR) inhibitor, but not calcineurin inhibitors (CNIs), has been shown to decrease spleen size. Small spleen, in some instances, is associated with hyposplenism, a condition recently reported in patients with longstanding renal transplant. Accordingly, the effect of immunosuppressive drugs on spleen size was evaluated.
Renal transplant recipients (35 taking mTOR and 68 CNI) were included, in whom a standardized investigation of the kidney allograft and spleen with the use of color Doppler ultrasound was performed and a peripheral smear were reviewed for the presence of Howell-Jolly bodies (HJBs).
We enrolled 103 patients (64 men; 66 from a deceased donor). The mean age was 47.7 years (range, 23.0-74.0 y). Mean transplant duration was 1,899 days (range, 181-6,883 d). According to the presence of HJBs, the prevalence of hyposplenism was 47.6% for the entire cohort. The differences between the mTOR and CNI groups regarding sex and the presence of HJBs were not statistically significant (P > .05). Age, creatinine, hemoglobin, leukocytes, platelets, and Doppler parameters in spleen and kidney were similar in both groups (P > .05). mTOR patients had a decreased spleen length size (90.09 ± 13.02 mm vs 111.95 ± 18.66 mm; P < .001), a longer transplant duration (3,576 ± 1,594 d vs 1,036 ± 1,369 d; P < .001) and higher serum cholesterol (227.50 ± 38.75 mg/dL vs 182.67 ± 37.74 mg/dL; P < .001) and triglycerides (194.23 ± 79.88 mg/dL vs 148.70 ± 55.54 mg/dL; P = .003) levels compared with the CNI group. A multivariate analysis showed mTOR inhibitor to be the most important predictor of spleen size. In both the mTOR and CNI groups, the comparison between the subgroups of present and absent HJBs did not show any difference.
The findings of this study suggest that small spleens in transplant recipients may be linked to treatment with an mTOR inhibitor, although this apparently does not compromise splenic function.
根据文献中的现有证据，雷帕霉素作为一种哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂，而非钙调神经磷酸酶抑制剂（CNI），已被证明可减小脾脏大小。在某些情况下，脾脏缩小与脾功能减退有关，脾功能减退是近期在长期肾移植患者中报道的一种病症。因此，对免疫抑制药物对脾脏大小的影响进行了评估。
纳入肾移植受者（35例服用mTOR，68例服用CNI），对其进行标准化的同种异体肾移植和脾脏彩色多普勒超声检查，并复查外周血涂片以检测Howell-Jolly小体（HJB）的存在情况。
我们纳入了103例患者（64例男性；66例来自已故供体）。平均年龄为47.7岁（范围为23.0 - 74.0岁）。平均移植时间为1899天（范围为181 - 6883天）。根据HJB的存在情况，整个队列中脾功能减退的患病率为47.6%。mTOR组和CNI组在性别和HJB存在情况方面的差异无统计学意义（P > 0.05）。两组在年龄、肌酐、血红蛋白、白细胞、血小板以及脾脏和肾脏的多普勒参数方面相似（P > 0.05）。与CNI组相比，服用mTOR的患者脾脏长度减小（90.09 ± 13.02 mm对111.95 ± 18.66 mm；P < 0.001），移植时间更长（3576 ± 1594天对1036 ± 1369天；P < 0.001），血清胆固醇水平更高（227.50 ± 38.75 mg/dL对182.67 ± 37.74 mg/dL；P < 0.001），甘油三酯水平更高（194.23 ± 79.88 mg/dL对148.70 ± 55.54 mg/dL；P = 0.003）。多因素分析显示mTOR抑制剂是脾脏大小的最重要预测因素。在mTOR组和CNI组中，有HJB和无HJB亚组之间的比较均未显示出任何差异。
本研究结果表明，移植受者脾脏缩小可能与使用mTOR抑制剂治疗有关，尽管这显然不会损害脾脏功能。
