Mabood Khalil Muhammad Abdul, Al-Ghamdi Saeed M G, Dawood Ubaidullah Shaik, Ahmed Khamis Said Sayed, Ishida Hideki, Chong Vui Heng, Tan Jackson
Department of Nephrology, RIPAS Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam.
Department of Medicine Faculty of Medicine, King Abdul Aziz University, Jeddah 21589, Saudi Arabia.
J Transplant. 2022 Feb 28;2022:6255339. doi: 10.1155/2022/6255339. eCollection 2022.
Mammalian target of rapamycin inhibitors (mTOR-I) lacks nephrotoxicity, has antineoplastic effects, and reduces viral infections in kidney transplant recipients. Earlier studies reported a significant incidence of wound healing complications and lymphocele. This resulted in the uncomfortable willingness of transplant clinicians to use these agents in the immediate posttransplant period. As evidence and experience evolved over time, much useful information became available about the optimal use of these agents. Understandably, mTOR-I effects wound healing through their antiproliferative properties. However, there are a lot of other immunological and nonimmunological factors which can also contribute to wound healing complications. These risk factors include obesity, uremia, increasing age, diabetes, smoking, alcoholism, and protein-energy malnutrition. Except for age, the rest of all these risk factors are modifiable. At the same time, mycophenolic acid derivatives, steroids, and antithymocyte globulin (ATG) have also been implicated in wound healing complications. A lot has been learnt about the optimal dose of mTOR-I and their trough levels, its combinations with other immunosuppressive medications, and patients' profile, enabling clinicians to use these agents appropriately for maximum benefits. Recent randomized control trials have further increased the confidence of clinicians to use these agents in immediate posttransplant periods.
雷帕霉素哺乳动物靶点抑制剂（mTOR-I）无肾毒性，具有抗肿瘤作用，并能减少肾移植受者的病毒感染。早期研究报告了伤口愈合并发症和淋巴囊肿的显著发生率。这导致移植临床医生在移植后即刻使用这些药物时存在顾虑。随着时间推移，证据和经验不断发展，关于这些药物最佳使用方法的许多有用信息得以获取。可以理解的是，mTOR-I通过其抗增殖特性影响伤口愈合。然而，还有许多其他免疫和非免疫因素也可能导致伤口愈合并发症。这些危险因素包括肥胖、尿毒症、年龄增长、糖尿病、吸烟、酗酒和蛋白质能量营养不良。除年龄外，所有这些危险因素都是可以改变的。同时，霉酚酸衍生物、类固醇和抗胸腺细胞球蛋白（ATG）也与伤口愈合并发症有关。人们已经了解了很多关于mTOR-I的最佳剂量及其谷浓度、与其他免疫抑制药物的联合使用以及患者情况的信息，这使临床医生能够合理使用这些药物以获得最大益处。近期的随机对照试验进一步增强了临床医生在移植后即刻使用这些药物的信心。
