依维莫司免疫抑制对肝移植受者肾功能的影响。

Impact of Everolimus-based Immunosuppression on Renal Function in Liver Transplant Recipients.

作者信息

Nogueras López Flor, Abellan Alfocea Patricia, Ortega Suazo Eva Julissa, López Garrido Maria Angeles, Becerra Massare Antonio, Gila Medina Ana María, Redondo Cerezo Eduardo, Espinosa Aguilar M Dolores

机构信息

Hepatology Department, Virgen de las Nieves University Hospital, Granada, Spain.

出版信息

Transplant Proc. 2020 Mar;52(2):556-558. doi: 10.1016/j.transproceed.2019.12.012. Epub 2020 Feb 6.

DOI:10.1016/j.transproceed.2019.12.012

PMID:32035673

Abstract

BACKGROUND

Calcineurin inhibitors have been implicated in acute and chronic kidney disease after liver transplant (LT). Everolimus (EVR) is a mammalian target of rapamycin inhibitor efficacious in preventing acute cellular rejection while preserving renal function among LT recipients. We evaluated the benefits on renal function of EVR immunosuppression in LT recipients.

METHODS

We performed a retrospective and observational study in 477 LT recipients in Virgen de las Nieves Hospital from 2002 to 2019 on the use of EVR with tacrolimus minimization or withdrawal in LT recipients with renal dysfunction. The study included 100 patients starting EVR (20.96%); in 66 (66%) the indication was renal dysfunction. The change in renal function was assessed by estimated glomerular filtration rate. Statistical analyses were performed using SPSS 17.0 software (IBM, Munich, Germany).

RESULTS

Fifty 8 patients received mycophenolate mofetil (87.8%), and tacrolimus therapy was stopped in 27 patients (40.9%). Induction therapy with basiliximab was administered in 41 patients (62.12%). There was significant difference between estimated glomerular filtration rate at the time of starting EVR and the first month at last follow-up (49.42 mL/min/1.73 m vs 75.27 mL/min/1.73 m; P < .001) and at end of follow-up (24 months) (49.42 mL/min/1.73 m vs 64.32 mL/min/1.73 m; P = .001). The rate of incidence of adverse events was 48.48% (32/66). Seven patients died during follow-up (10.6%), but there were no EVR-related deaths. Eleven patients (16.6%) developed biopsy-proven acute rejection.

CONCLUSION

This study showed that EVR is associated with a beneficial effect on glomerular filtration rate in both the short and long term in LT recipients.

摘要

背景

钙调神经磷酸酶抑制剂与肝移植（LT）后的急慢性肾病有关。依维莫司（EVR）是一种雷帕霉素哺乳动物靶点抑制剂，在预防LT受者急性细胞排斥反应的同时能保留肾功能。我们评估了EVR免疫抑制对LT受者肾功能的益处。

方法

我们对2002年至2019年在比维斯·德拉斯涅韦斯医院的477例LT受者进行了一项回顾性观察研究，这些受者在肾功能不全的情况下使用EVR并尽量减少或停用他克莫司。该研究纳入了100例开始使用EVR的患者（20.96%）；其中66例（66%）的指征是肾功能不全。通过估算肾小球滤过率评估肾功能变化。使用SPSS 17.0软件（IBM，德国慕尼黑）进行统计分析。

结果

58例患者接受了霉酚酸酯（87.8%），27例患者（40.9%）停止了他克莫司治疗。41例患者（62.12%）接受了巴利昔单抗诱导治疗。开始使用EVR时与最后一次随访第一个月时的估算肾小球滤过率之间存在显著差异（49.42 mL/min/1.73 m² 对75.27 mL/min/1.73 m²；P <.001），随访结束时（24个月）也存在显著差异（49.42 mL/min/1.73 m² 对64.32 mL/min/1.73 m²；P =.001）。不良事件发生率为48.48%（32/66）。7例患者在随访期间死亡（10.6%），但没有与EVR相关的死亡病例。11例患者（16.6%）发生了活检证实的急性排斥反应。