Tinti F, Umbro I, Poli L, Cappoli A, Garofalo M, Bachetoni A, D'Alessandro M D, Lai S, Berloco P B, Mitterhofer A P
Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy.
Department of General Surgery, Organ Transplant Unit, Sapienza University of Rome, Rome, Italy.
Transplant Proc. 2019 Jan-Feb;51(1):147-152. doi: 10.1016/j.transproceed.2018.04.076. Epub 2018 Jun 30.
Close monitoring of estimated glomerular filtration rate (eGFR) is important for early recognition of worsening renal function to prevent further deterioration. Safe conversion from twice-daily tacrolimus (TD-Tac) to once-daily tacrolimus (OD-Tac) has been reported, but the effects on eGFR are contrasting. The aim of our study is to evaluate long-term stability of eGFR after 1:1 conversion from TD-Tac to OD-Tac and the effects on serum cytokine blood levels. Forty-six consecutive kidney transplant recipients treated with TD-Tac 3 to 5 years post-transplant, with stable renal function, were enrolled in the study (2009-2011). Clinical and biochemical parameters were evaluated for 12 months before conversion up to 6 years after conversion. The patients served as their own controls. A panel of cytokines was evaluated repeatedly during the first year after conversion. Mean values of eGFR were not different long-term after conversion (P = .11) compared with baseline, and the majority of patients remained stable on Kidney Disease: Improving Global Outcomes stage during the study period; eGFR was stable in 30.0% after 5 years, decreased > 1 mL/min/1.73 m/y in 13.3%, and improved > 1 mL/min/1.73 m/y in 56.7%. Cytokine levels and C-reactive protein did not show any significant deterioration. Metabolic parameters were stable during the 6 years of follow-up. OD-Tac therapy can preserve an effective immunosuppressive state together with a safe profile of eGFR.
密切监测估算肾小球滤过率（eGFR）对于早期识别肾功能恶化以防止进一步恶化很重要。已有报道称他克莫司每日两次（TD-Tac）安全转换为他克莫司每日一次（OD-Tac），但对eGFR的影响却相互矛盾。我们研究的目的是评估从TD-Tac 1:1转换为OD-Tac后eGFR的长期稳定性以及对血清细胞因子血水平的影响。连续纳入46例移植后3至5年接受TD-Tac治疗且肾功能稳定的肾移植受者（2009 - 2011年）。在转换前12个月直至转换后6年评估临床和生化参数。患者自身作为对照。在转换后的第一年重复评估一组细胞因子。转换后长期eGFR的平均值与基线相比无差异（P = 0.11），并且在研究期间大多数患者在改善全球肾脏病预后组织（KDIGO）分期保持稳定；5年后30.0%的患者eGFR稳定，13.3%的患者eGFR下降>1 mL/min/1.73 m²/年，56.7%的患者eGFR改善>1 mL/min/1.73 m²/年。细胞因子水平和C反应蛋白未显示任何显著恶化。在6年的随访期间代谢参数稳定。OD-Tac治疗可维持有效的免疫抑制状态以及eGFR的安全状态。
