Kumar Jayant, Reccia Isabella, Kusano Tomokazu, Julie Bridson M, Sharma Ajay, Halawa Ahmed
Jayant Kumar, Isabella Reccia, Tomokazu Kusano, Department of Cancer and Surgery, Imperial College, London W120HS, United Kingdom.
World J Transplant. 2017 Apr 24;7(2):144-151. doi: 10.5500/wjt.v7.i2.144.
To consolidate the present evidence of effectiveness in renal functioning and graft survival following early introduction of mammalian target of rapamycin (mTOR) inhibitors with or without calcineurin inhibitors (CNIs) in renal transplant recipients.
We analysed the current literature following PROSPERO approval describing the role of immunosuppressive agent, mTOR inhibitors as an alternative to CNI within six months of renal transplant by searching the PubMed, EMBASE, Cochrane, Crossref, and Scopus using MeSH terms.
Six articles of early withdrawal of CNI and introduction of mTOR-inhibitors within six months of renal transplantation were sought. Glomerular filtration rate (GFR) and serum creatinine were significantly better in mTOR inhibitor group with equivalent survival at 12 mo, even though Biopsy Proven Acute rejection was significantly higher in mTOR-inhibitor group.
The evidence reviewed in this meta-analysis suggests that early introduction mTOR-inhibitors substantial CNI minimization. The mTOR inhibitors such as everolimus and sirolimus, due to their complementary mechanism of action and favourable nephrotoxicity profile; better glomerular filtration, lower serum creatinine with equivalent survival. Having said that, due to the higher rejection rate, may influence the use of these regimens to patients with moderate to high immunological risk patients.
巩固目前关于肾移植受者早期使用或不使用钙调神经磷酸酶抑制剂（CNIs）的雷帕霉素靶蛋白（mTOR）抑制剂后肾功能和移植物存活有效性的证据。
我们在PROSPERO批准后分析了当前文献，通过使用医学主题词在PubMed、EMBASE、Cochrane、Crossref和Scopus中检索，描述免疫抑制剂mTOR抑制剂在肾移植后六个月内替代CNI的作用。
检索到六篇关于肾移植后六个月内早期停用CNI并引入mTOR抑制剂的文章。mTOR抑制剂组的肾小球滤过率（GFR）和血清肌酐明显更好，12个月时存活率相当，尽管mTOR抑制剂组经活检证实的急性排斥反应明显更高。
该荟萃分析中综述的证据表明，早期引入mTOR抑制剂可显著减少CNI的使用。依维莫司和西罗莫司等mTOR抑制剂，由于其互补的作用机制和良好的肾毒性特征；具有更好的肾小球滤过、更低的血清肌酐和相当的存活率。话虽如此，由于排斥率较高，可能会影响这些方案在中高免疫风险患者中的应用。
