Improvement of impaired renal function in heart transplant recipients treated with mycophenolate mofetil and low-dose cyclosporine.
Improvement of impaired renal function in heart transplant recipients treated with mycophenolate mofetil and low-dose cyclosporine.
复制标题
用吗替麦考酚酯和低剂量环孢素治疗心脏移植受者受损的肾功能得到改善。
作者：
I. Aleksic;M. Baryalei;T. Busch;B. Pieske;B. Schorn;J. Strauch;H. Sîrbu;H. Dalichau
背景
环孢素（CsA）肾毒性是心脏移植后的常见问题。我们研究了与霉酚酸酯 (MMF) 治疗相关的 CsA 剂量减少对疑似 CsA 肾毒性（血清肌酐水平 > 2 mg/dl）的心脏移植受者肾功能的影响。
方法
12 名心脏移植受者（11 名男性，1 名女性；移植后 111 至 1813 天）接受基于 CsA 的免疫抑制（加硫唑嘌呤和/或类固醇）且血清肌酐水平 >2.0 mg/dl，开始每日剂量 2000 mg MMF。 9名患者的基础疾病为扩张型心肌病，3名患者的基础疾病为缺血性心肌病。患者平均年龄为 57 岁（范围 44-69 岁）。停用硫唑嘌呤并缓慢减量 CsA。监测肌酐清除率、血清肌酐水平、尿素氮和尿酸。测量 CsA 水平，并将 CsA 剂量调整为全血水平 70-120 µg/L。十名患者仍进行了心内膜心肌活检，而一名患者仅进行了超声心动图对照。
结果
根据 ISHLT（国际心肺移植协会）的规定，在改用 MMF 后 1 年内观察到一次 1B 级排斥反应。一名患者因胃肠道副作用而被排除。
结论
在肾功能受损的心脏移植受者中，从硫唑嘌呤转换为 MMF 并连续减少 CsA 可改善肾功能，血清肌酐、尿素氮、尿酸降低和肌酐清除率升高即可证明。
BACKGROUND
Cyclosporine (CsA) nephrotoxicity is a common problem after cardiac transplantation. We have studied the impact of CsA dose reduction in association with mycophenolate mofetil (MMF) treatment on renal function in heart transplant recipients with suspected CsA nephrotoxicity (serum creatinine level >2 mg/dl).
METHODS
Twelve heart transplant recipients (11 men, 1 woman; 111 to 1813 days after transplantation) with CsA-based immunosuppression (plus azathioprine and/or steroids) and a serum creatinine level >2.0 mg/dl were started on a daily dose of 2000 mg of MMF. Dilated cardiomyopathy was the underlying disease in nine patients, ischemic cardiomyopathy in three patients. Mean patient age was 57 years (range 44-69 years). Azathioprine was discontinued and CsA slowly tapered. Creatinine clearance, serum creatinine level, urea nitrogen, and uric acid were monitored. CsA levels were measured, and CsA dose was adjusted for whole blood levels of 70-120 microg/L. Ten patients still had endomyocardial biopsies, whereas one had echocardiographic controls only.
RESULTS
One grade 1B rejection episode according to ISHLT (International Society for Heart and Lung Transplantation) was observed until 1 year after the switch to MMF. One patient was excluded due to gastrointestinal side effects.
CONCLUSIONS
Conversion from azathioprine to MMF with consecutive reduction of CsA in heart transplant recipients with CsA-impaired renal function improves renal function as evidenced by lower serum creatinine, urea nitrogen, uric acid, and higher creatinine clearance.
影响因子：
19.6
作者：
MYERS, BD;SIBLEY, R;PERLROTH, MG
通讯作者：
PERLROTH, MG