Increased risk of venous thromboembolism with a sirolimus-based immunosuppression regimen in lung transplantation
Increased risk of venous thromboembolism with a sirolimus-based immunosuppression regimen in lung transplantation
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DOI：
10.1016/j.healun.2010.08.010
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发表时间：
2011-02-01
影响因子：
8.9
通讯作者：
Bhorade, Sangeeta
中科院分区：
文献类型：
--
作者：
Ahya, Vivek N.;McShane, Pamela J.;Bhorade, Sangeeta
背景：西罗莫司(雷帕霉素)是一种有效的抗增殖剂，具有免疫抑制作用，正越来越多地用于实体器官和造血干细胞移植。此外，这种药物正在被研究用于治疗一系列疾病，包括心血管疾病、恶性肿瘤、结节性硬化症和淋巴管肌瘤病。在这项研究中，我们发现接受基于西罗莫司(SIR)的免疫抑制方案治疗的肺移植受者静脉血栓栓塞症(VIE)的风险增加。方法：181名肺移植受者参加了一项前瞻性、多中心、随机、开放的试验，比较了他克莫司/SIR/强的松免疫抑制方案和他克莫司/硫唑嘌呤/强的松免疫抑制方案。结果：SIR组VTE发生率[15/87(17.2%)]显著高于AZA组[3/94(3.2%)](分层对数统计量=7.44，p<；0.01)。当根据移植前诊断进行调整并按移植中心分层后，这一差异基本保持不变(SIR与AZA的风险比=5.2，95%可信区间1.4-19.5，P=0.01)。结论：临床医生在开SIR时应对VTE保持高度警惕，特别是在有其他危险因素的患者。J心肺移植杂志2011；30：175-81(C)2011国际心肺移植学会。版权所有。
BACKGROUND: Sirolimus (rapamycin) is a potent anti-proliferative agent with immunosuppressive properties that is increasingly being used in solid-organ and hematopoietic stem cell transplantation. In addition, this drug is being investigated for treatment of a broad range of disorders, including cardiovascular disease, malignancies, tuberous sclerosis, and lymphangeioleiomyomatosis. In this study, we found an increased risk of venous thromboembolism (VIE) in lung transplant recipients treated with a sirolimus (SIR)-based immunosuppressive regimen.METHODS: One hundred eighty-one lung transplant recipients were enrolled in a prospective, multi-center, randomized, open-label trial comparing a tacrolimus (TAC)/SIR/prednisone immunosuppression regimen with a TAC/azathioprine (AZA)/prednisone immunosuppressive regimen. The differences in rates of VTE were examined.RESULTS: There was a significantly higher occurrence of VTE in the SIR cohort [15 of 87 (17.2%)] compared with the AZA cohort [3 of 94 (3.2%)] (stratified log-rank statistic = 7.44, p < 0.01). When adjusted for pre-transplant diagnosis and stratified by transplant center, this difference remained essentially unchanged (hazard ratio for SIR vs AZA = 5.2, 95% confidence interval 1.4 to 19.5, p = 0.01).CONCLUSION: Clinicians prescribing SIR should maintain a high level of vigilance for VTE, particularly among patients with other risk factors for this complication. J Heart Lung Transplant 2011;30:175-81 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.