Division of Transplantation, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
Department of Abdominal Surgery and Transplantation, University of Liège, Liège, Belgium.
Transplantation. 2018 Feb;102(2S Suppl 1):S30-S31. doi: 10.1097/TP.0000000000001700.
This brief overview discusses the beneficial and deleterious effects of mammalian target of rapamycin (mTOR) inhibitors on β cells, and how sirolimus- and everolimus-based immunosuppression have impacted on practices and outcomes of pancreas and islet transplantation. Sirolimus was the cornerstone of immunosuppressive regimens in islet transplantation at the turn of the millenium, but utilization of mTOR inhibitors has progressively decreased from greater than 80% to less than 50% of islet transplant recipients in more recent years. For whole pancreas transplantation, mTOR inhibitors were used in approximately 20% of patients in the early 2000s, but this dropped over the years to less than 10% currently. This decrease is arguably due to less well-tolerated side effects without the advantage of better outcomes. Nonetheless, mTOR inhibitors remain extremely valuable as second-line immunosuppressants in pancreas and islet transplantation.
本文简要概述了雷帕霉素靶蛋白（mTOR）抑制剂对β细胞的有益和有害影响，以及基于西罗莫司和依维莫司的免疫抑制对胰腺和胰岛移植实践和结果的影响。西罗莫司是千禧年之交胰岛移植免疫抑制方案的基石，但近年来，mTOR 抑制剂的使用率已从胰岛移植受者的 80%以上降至 50%以下。在全胰腺移植中，mTOR 抑制剂在 21 世纪初约有 20%的患者使用，但近年来降至目前的不到 10%。这种减少可以说是由于副作用耐受性较差，而没有更好的结果优势。尽管如此，mTOR 抑制剂在胰腺和胰岛移植中仍然是非常有价值的二线免疫抑制剂。
