Rubín Suárez Angel, Bilbao Aguirre Itxarone, Fernández-Castroagudin Javier, Pons Miñano José Antonio, Salcedo Plaza Magdalena, Varo Pérez Evaristo, Prieto Castillo Martín
Unidad de Hepatología, Servicio de Medicina Digestiva, Área de Enfermedades Digestivas, Hospital Universitari i Politècnic La Fe, CIBERehd, Valencia, España.
Servicio de Cirugía HBP y Trasplantes Digestivos, Hospital Universitario Vall d'Hebrón. Grupos de investigación VHIR y CIBERehd, Barcelona, España.
Gastroenterol Hepatol. 2017 Nov;40(9):629-640. doi: 10.1016/j.gastrohep.2017.05.008. Epub 2017 Jul 23.
Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice.
雷帕霉素哺乳动物靶点（mTOR）抑制剂依维莫司（EVL）和西罗莫司是具有轻微肾毒性作用的免疫抑制剂，在某些情况下仅限于蛋白尿的发生。已证明EVL与低剂量他克莫司联合使用在预防急性细胞排斥反应方面与他克莫司标准治疗一样安全有效。早期启动基于EVL的免疫抑制方案并减少钙调神经磷酸酶抑制剂的暴露已显示在诱导和维持阶段可显著改善肝移植受者的肾功能，且疗效和安全性相当。在已确诊肾衰竭的患者中，启动EVL可能使临床医生减少钙调神经磷酸酶抑制剂的暴露，从而有助于改善这些患者的肾功能。尽管没有足够的证据推荐使用它们来预防肝细胞癌复发和新发肿瘤进展，但在常规临床实践中它们被用于这种情况。
