Chiang Heng-Yi, Li Lung-Chih, Hsu Chien-Ning, Lin Chih-Che, Chan Yi-Chia, Wang Chih-Chi, Chen Chao-Long
Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
Pharmaceuticals (Basel). 2023 Jul 31;16(8):1087. doi: 10.3390/ph16081087.
Impaired kidney function is associated with increased morbidity and mortality in patients undergoing liver transplantation. Although immunosuppressants are essential in these patients, they impair kidney function. This study aimed to compare adverse kidney outcomes between patients treated with a reduced dose of tacrolimus (calcineurin inhibitor) plus sirolimus or mycophenolate mofetil (MMF) in the liver transplant center at Kaohsiung Chang Gung Memorial Hospital between April 2011 and December 2017. Propensity score matching was used to identify 232 patients. The risk of adverse kidney outcomes was estimated using Cox proportional hazards regression, and changes in kidney function over time were analyzed using linear mixed modeling. Acute kidney disease risks in this study cohort were not significantly different for the two immunosuppressants (aHR 1.04; 95% CI: 0.70-1.55, = 0.8328). However, sirolimus use was significantly associated with a higher risk of estimated glomerular filtration rate decline > 30% than MMF (aHR, 2.09; 95% CI: 1.33-3.28; = 0.0014). Our results demonstrate that sirolimus use may have worsened long-term kidney outcomes compared to MMF. Close monitoring of kidney function, dose adjustment, and timely transition to MMF is necessary for LT patients receiving sirolimus.
肾功能受损与肝移植患者发病率和死亡率的增加相关。尽管免疫抑制剂对这些患者至关重要，但它们会损害肾功能。本研究旨在比较2011年4月至2017年12月期间高雄长庚纪念医院肝移植中心接受低剂量他克莫司（钙调神经磷酸酶抑制剂）联合西罗莫司或霉酚酸酯（MMF）治疗的患者的不良肾脏结局。采用倾向评分匹配法确定了232例患者。使用Cox比例风险回归估计不良肾脏结局的风险，并使用线性混合模型分析肾功能随时间的变化。本研究队列中，两种免疫抑制剂的急性肾疾病风险无显著差异（调整后风险比1.04；95%置信区间：0.70-1.55，P = 0.8328）。然而，与MMF相比，使用西罗莫司与估计肾小球滤过率下降>30%的风险显著相关（调整后风险比，2.09；95%置信区间：1.33-3.28；P = 0.0014）。我们的结果表明，与MMF相比，使用西罗莫司可能会使长期肾脏结局恶化。对于接受西罗莫司治疗的肝移植患者，有必要密切监测肾功能、调整剂量并及时转换为MMF。
