Melton Tanner A, Fenske Molly W, Bernard Stacy A, Cole Kristin C, Pennington Kelly M, Lemke Adley I
Department of Pharmacy, Mayo Clinic Hospital, Rochester, MN 55905, USA.
Department of Quantitative Health Sciences, Mayo Clinic Hospital, Rochester, MN 55905, USA.
Medicines (Basel). 2025 Aug 28;12(3):22. doi: 10.3390/medicines12030022.
Reversible and irreversible nephrotoxicity are known complications of tacrolimus. Approaches to reduce the incidence of nephrotoxicity include the reduction or avoidance of tacrolimus but must be weighed against risk of rejection. Infrequently, basiliximab has been used outside of the induction period to facilitate temporary tacrolimus cessation in the setting of acute kidney injury (AKI). The primary objective of this study was to describe renal recovery after temporary tacrolimus cessation with non-induction basiliximab (NIB) compared to a matched cohort. We conducted a single-center study of adult cardiothoracic transplant recipients that received basiliximab beyond post-operative day 7 for temporary tacrolimus cessation in the setting of AKI between January 2019 and November 2023 and matched them to acontrol cohort. Twelve patients underwent temporary tacrolimus cessation with NIB. In total, 7 (58%) patients achieved initial renal recovery at tacrolimus resumption compared to 15 (42%) patients in the matched cohort at an equivalent time point. No difference between treated rejection (17% vs. 19%, = 0.80) or infection (75% vs. 50%, = 0.32) was observed between tacrolimus cessation and its matched cohort. The use of NIB for tacrolimus cessation can allow for potential renal recovery after an AKI or in patients at risk of AKI. This approach does not appear to significantly increase the risk of rejection but may increase the risk of infection in the long term.
可逆性和不可逆性肾毒性是他克莫司已知的并发症。降低肾毒性发生率的方法包括减少或停用他克莫司，但必须权衡排斥反应的风险。在诱导期之外，有时会使用巴利昔单抗来促进急性肾损伤（AKI）患者暂时停用他克莫司。本研究的主要目的是描述与匹配队列相比，在使用非诱导期巴利昔单抗（NIB）暂时停用他克莫司后肾脏的恢复情况。我们对2019年1月至2023年11月期间因AKI而在术后第7天之后接受巴利昔单抗以暂时停用他克莫司的成人心胸移植受者进行了单中心研究，并将他们与一个对照队列进行匹配。12例患者使用NIB暂时停用他克莫司。总共7例（58%）患者在恢复使用他克莫司时实现了初始肾脏恢复，而在匹配队列中的15例（42%）患者在相同时间点实现了恢复。在停用他克莫司组与其匹配队列之间，未观察到治疗排斥反应（17%对19%，P = 0.80）或感染（75%对50%，P = 0.32）方面的差异。使用NIB停用他克莫司可使AKI患者或有AKI风险的患者实现潜在的肾脏恢复。这种方法似乎不会显著增加排斥反应的风险，但从长远来看可能会增加感染的风险。
