钙调磷酸酶抑制剂肾毒性预防策略：重点关注基于贝利尤单抗的挽救性免疫治疗：对现有证据的综述。
Calcineurin Inhibitors Nephrotoxicity Prevention Strategies With Stress on Belatacept-Based Rescue Immunotherapy: A Review of the Current Evidence.
机构信息
Transplant Surgery Section, Surgery Department, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia.
Transplant Surgery Section, Surgery Department, Armed Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia.
出版信息
Transplant Proc. 2021 Jun;53(5):1532-1540. doi: 10.1016/j.transproceed.2021.03.028. Epub 2021 May 18.
BACKGROUND
A traditional narrative review was performed to evaluate clinical studies that have examined the clinical implications, risk factors, and prevention of calcineurin inhibitors (CNIs) nephrotoxicity with stress on a belatacept-based rescue regimen.
METHODS
The Cochrane Library, PubMed/MEDLINE, EBSCO (Academic Search Ultimate), ProQuest (Central), and Excerpta Medical databases and Google scholar were searched using the keywords (CNI AND Nephrotoxicity prevention) OR ("Calcineurin inhibitor" AND Nephrotoxicity) OR (Tacrolimus AND Nephrotoxicity) OR (Ciclosporin AND Nephrotoxicity) OR (cyclosporine AND Nephrotoxicity) OR (Belatacept) OR (CNI Conversion) for the period from 1990 to 2020. Fifty-five related articles and reviews were found.
CONCLUSION
A better understanding of the mechanisms underlying calcineurin inhibitor nephrotoxicity could help in the individualization of therapy for and prevention of CNI nephrotoxicity. Identification of high-risk patients for CNI nephrotoxicity before renal transplantation enables better use and selection of immunosuppression with reduced adverse effects and, eventually, successful treatment of the kidney recipients. Belatacept conversion is a good and safe option in patients with deteriorating renal function attributed to CNI nephrotoxicity.
背景
进行了传统的叙述性综述，以评估检查钙调神经磷酸酶抑制剂（CNI）肾毒性的临床意义、危险因素和预防的临床研究，并强调基于贝利尤单抗的抢救方案。
方法
使用关键词（CNI 和肾毒性预防）或（“Calcineurin inhibitor”和肾毒性）或（Tacrolimus 和肾毒性）或（Ciclosporin 和肾毒性）或（环孢素和肾毒性）或（Belatacept）或（CNI 转换）在 Cochrane Library、PubMed/MEDLINE、EBSCO（学术搜索终极版）、ProQuest（中央）和 Excerpta Medical 数据库以及 Google scholar 中搜索，时间范围为 1990 年至 2020 年。共找到 55 篇相关文章和综述。
结论
更好地了解钙调神经磷酸酶抑制剂肾毒性的机制有助于实现个体化治疗和预防 CNI 肾毒性。在肾移植前识别出有发生 CNI 肾毒性风险的高危患者，可以更好地使用和选择免疫抑制药物，减少不良反应，最终成功治疗肾脏受者。对于因 CNI 肾毒性导致肾功能恶化的患者，转换为贝利尤单抗是一种良好且安全的选择。
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