Simultaneous corticosteroid avoidance and calcineurin inhibitor minimization in renal transplantation.
Simultaneous corticosteroid avoidance and calcineurin inhibitor minimization in renal transplantation.
复制标题
肾移植中同时避免皮质类固醇和尽量减少钙调神经磷酸酶抑制剂。
DOI：
10.1111/j.1432-2277.2006.00280.x
复制
发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Woo
中科院分区：
文献类型：
--
作者：
Alexander,JWesley;Goodman,HopeR;Cardi,Michael;Austin,Joe;Goel,Sharad;Safdar,Shahzad;Huang,Shaoming;Munda,Rino;Fidler,JamesP;Buell,JosephF;Hanaway,Michael;Susskind,Brian;Roy-Chaudhury,Prabir;Trofe,Jennifer;Alloway,Rita;Woo
类固醇和钙调神经磷酸酶抑制剂（CNI）一直是免疫抑制的主要药物，但两者都有许多副作用，与大量的发病率和死亡率相关。本研究的目的是确定是否可以通过提前停用环孢素 A (CsA) 和稍后停用吗替麦考酚酯 (MMF) 来消除类固醇。九十六名肾移植患者被纳入两项试点研究的四个亚组。所有患者均接受胸腺球蛋白®诱导、雷帕霉素 (RAPA) 以及免疫营养素精氨酸和含有 ω-3 脂肪酸的油。吗替麦考酚酯开始使用标准剂量，并在 2 年后停药。 CsA 剂量减少，持续 4、6 或 12 个月。随访时间为 12-36 个月。第一年发生了 13 次首次拒绝事件（14%）。综合所有患者，86% 在 1 年时无排斥反应，80% 在 2 年时无排斥反应，79% 在 3 年时无排斥反应。没有因急性排斥反应而丧失肾脏。研究结束时，84 名处于危险中的患者中有 90% 没有使用类固醇，87% 没有使用 CNI。 54 名 3 年时肾脏功能正常的患者中，57% 正在接受 RAPA 单一疗法。我们的结论是，这种治疗策略值得进行前瞻性多中心临床试验。
Steroids and calcineurin inhibitors (CNI) have been mainstays of immunosuppression but both have numerous side effects that are associated with substantial morbidity and mortality. This study was carried out to determine if steroids can be eliminated with early discontinuation of cyclosporine A (CsA) and later discontinuation of mycophenolate mofetil (MMF). Ninety‐six patients with kidney transplants were entered into four subgroups of two pilot studies. All patients received Thymoglobulin®induction, rapamycin (RAPA), and the immunonutrients arginine and an oil containingω‐3 fatty acids. Mycophenolate mofetil was started in standard doses and discontinued by 2 years. CsA was given in reduced doses for either 4, 6, or 12 months. Follow‐up was 12–36 months. Thirteen first rejection episodes occurred during the first year (14%). Combining all patients, 86% were rejection‐free at 1 year, 80% at 2 years and 79% at 3 years. No kidney has been lost to acute rejection. Ninety percent of the 84 patients at risk at the end of the study were steroid‐free and 87% were off CNI. Fifty‐seven percent of 54 patients with a functioning kidney at 3 years were receiving monotherapy with RAPA. We conclude that this therapeutic strategy is worthy of a prospective multi‐center clinical trial.