Tinti Francesca, Schiaffini Gabriele, Umbro Ilaria, Zavatto Assunta, Poli Luca, Pretagostini Renzo, Garofalo Manuela, Bachetoni Alessandra, Lai Silvia, D'Alessandro Maria Domenica, Mitterhofer Anna Paola
Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
Transplant Proc. 2020 Jun;52(5):1547-1551. doi: 10.1016/j.transproceed.2020.02.079. Epub 2020 Apr 16.
The decline of allograft kidney function in the long term remains a significant issue in renal transplantation, with drug nephrotoxicity and cardiovascular complications as important risk factors. Our study aimed to evaluate the estimated glomerular filtration rate (eGFR) trend and metabolic cardiovascular risk factors over 10 years in a cohort of kidney transplant (KT) recipients converted from twice-daily (TD) tacrolimus (Tac) to once-daily (OD)-Tac. We enrolled 55 consecutive KT recipients who had been at the outpatient clinic between 2009 and 2011. Thirty-seven reached the 10-year follow-up. We compared the observed eGFR with the expected eGFR trend described in KT-recipients and monitored blood pressure and metabolic cardiovascular risk factors. The observed eGFR remained stable throughout the complete follow-up (P = .188). The observed decline of eGFR was significantly lower compared with the expected decline for KT patients (P < .001). The blood pressure was maintained within target values. The monitoring of plasma glucose levels demonstrated the stability of median values (P = .686), as well as cholesterol level (P = .250), high-density lipoprotein (HDL) cholesterol (P = .294), and triglycerides (P = .592) throughout the follow-up. The monitoring of tacrolimus plasma level demonstrated that median trough levels remained constant (median values 4.4-5.5 ng/mL) throughout the entire follow-up period (P = .149). We suggest that the reasonable control of metabolic risk factors for cardiovascular disease over long-term follow-up may significantly contribute to the preservation of eGFR compared with the decline expected in KT recipients.
长期来看，同种异体移植肾功能的下降仍是肾移植中的一个重大问题，药物肾毒性和心血管并发症是重要的风险因素。我们的研究旨在评估一组从每日两次（TD）他克莫司（Tac）转换为每日一次（OD）他克莫司的肾移植（KT）受者在10年期间的估计肾小球滤过率（eGFR）趋势和代谢性心血管危险因素。我们纳入了2009年至2011年期间在门诊连续就诊的55名KT受者。37名受者完成了10年随访。我们将观察到的eGFR与KT受者中描述的预期eGFR趋势进行比较，并监测血压和代谢性心血管危险因素。在整个随访期间，观察到的eGFR保持稳定（P = 0.188）。与KT患者的预期下降相比，观察到的eGFR下降显著更低（P < 0.001）。血压维持在目标值范围内。血浆葡萄糖水平监测显示中位数在随访期间保持稳定（P = 0.686），胆固醇水平（P = 0.250）、高密度脂蛋白（HDL）胆固醇（P = 0.294）和甘油三酯（P = 0.592）也是如此。他克莫司血浆水平监测显示在整个随访期间中位数谷浓度保持恒定（中位数4.4 - 5.5 ng/mL）（P = 0.149）。我们认为，与KT受者预期的下降相比，在长期随访中合理控制心血管疾病的代谢危险因素可能对eGFR的保存有显著贡献。
