Kojima Cristiane Akemi, Nga Hong Si, Takase Henrique Mochida, Bravin Ariane Moyses, Martinez Garcia Márcia de Fátima Faraldo, Garcia Paula Dalsoglio, Contti Mariana Moraes, de Andrade Luis Gustavo Modelli
Department of Internal Medicine, Univ Estadual Paulista, Botucatu, Brazil.
Exp Clin Transplant. 2018 Jun;16(3):301-306. doi: 10.6002/ect.2016.0335. Epub 2017 Aug 28.
There is no consensus on the best immunosuppressive regimen for elderly renal transplant recipients. The objective of this study was to assess cytomegalovirus infection incidence and kidney transplant outcomes in elderly recipients treated with mammalian target of rapamycin inhibitors sirolimus/ tacrolimus at low doses compared with those receiving tacrolimus/mycophenolate sodium.
In this single-center prospective randomized study (Trial Registration No. NCT02683291), kidney transplant recipients over 60 years of age were randomly allocated into 2 groups: tacrolimus-sirolimus (21 patients) and tacrolimus-mycophenolate (23 patients). Cytomegalovirus infection rate and patient survival, biopsy-proven acute rejection, and renal function at 12 months were assessed.
Cytomegalovirus infection rate was higher in the mycophenolate group (60.9%) than in the sirolimus group (16.7%; P = .004). The rates of biopsy-proven acute rejection, patient survival, graft survival, and estimated glomerular filtration rate over 12 months did not significantly differ between groups.
The incidence of cytomegalovirus infection was significantly lower in the sirolimus group. The use of tacrolimus combined with sirolimus in elderly kidney transplant recipients is safe.
对于老年肾移植受者的最佳免疫抑制方案尚无共识。本研究的目的是评估与接受他克莫司/麦考酚钠的老年受者相比，接受低剂量雷帕霉素靶蛋白抑制剂西罗莫司/他克莫司治疗的老年受者的巨细胞病毒感染发生率和肾移植结局。
在这项单中心前瞻性随机研究（试验注册号：NCT02683291）中，60岁以上的肾移植受者被随机分为两组：他克莫司-西罗莫司组（21例患者）和他克莫司-麦考酚酯组（23例患者）。评估巨细胞病毒感染率、患者生存率、活检证实的急性排斥反应以及12个月时的肾功能。
麦考酚酯组的巨细胞病毒感染率（60.9%）高于西罗莫司组（16.7%；P = 0.004）。两组之间活检证实的急性排斥反应率、患者生存率、移植物生存率以及12个月内的估计肾小球滤过率无显著差异。
西罗莫司组的巨细胞病毒感染发生率显著较低。在老年肾移植受者中使用他克莫司联合西罗莫司是安全的。
