Time to Conversion to an Everolimus-Based Regimen: Renal Outcomes in Liver Transplant Recipients From the EVEROLIVER Registry
Time to Conversion to an Everolimus-Based Regimen: Renal Outcomes in Liver Transplant Recipients From the EVEROLIVER Registry
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DOI：
10.1002/lt.25879
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发表时间：
2020-10-12
影响因子：
4.6
通讯作者：
Dumortier, Jerome
中科院分区：
文献类型：
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作者：
Saliba, Faouzi;Dharancy, Sebastien;Dumortier, Jerome
长期使用钙调磷酸酶抑制剂（CNI）为基础的方案是肝移植受者（LTR）慢性肾功能衰竭的主要原因之一。依维莫司肝脏登记研究（EVEROLIVER）评价了转换为依维莫司（EVR）的LTR的肾功能。该观察性登记研究包括法国9家临床试验机构接受EVR的所有LTR。在电子数据库中收集了10年（12次访视/患者）的数据，以评价EVR在临床实践中使用的疗效、肾功能（估计的肾小球滤过率[eGFR]）和安全性，目前的分析报告了长达60个月的结果。截至2017年9月，1045例患者在平均3.6 +/- 5.1年后接受了EVR。截至第60个月，57.7%的患者可以退出CNI。基线eGFR = 60 mL/min/1.73 m的患者平均eGFR改善（2）。慢性肾脏疾病患者（CKD;基线eGFR = 60 mL/min/1.73 m2）第36个月。在12个月后转换（晚期转换）的患者中，分别只有20.9%和17.4%在36个月和60个月时出现改善。对CKD分期≥ 3的患者进行的logistic回归分析表明，晚期转换、年龄和女性与eGFR（≥ 60 mL/min/1.73 m2）无改善相关。来自EVR实际使用的数据表明，即使在晚期CKD患者中，肾功能也从转换前阶段维持到36个月。然而，早期而不是晚期转换似乎是一种安全的方法，以保持长期肾功能的LTR。
Longterm use of a calcineurin inhibitor (CNI)-based regimen is one of the major reasons for chronic renal failure in liver transplantation recipients (LTRs). The Everolimus Liver registry (EVEROLIVER) evaluated renal function in LTRs who were converted to everolimus (EVR). This observational registry included all LTRs receiving EVR across 9 centers from France. Data are being collected in an electronic database over 10 years (12 visits/patient) to evaluate efficacy, renal function (estimated glomerular filtration rate [eGFR]), and safety of EVR use in clinical practice, and the current analysis is reporting up to 60 months of findings. Until September 2017, 1045 patients received EVR after a mean time of 3.6 +/- 5.1 years. CNI withdrawal was feasible in 57.7% of patients as of month 60. Mean eGFR improved in patients with baseline eGFR = 60 mL/minute/1.73 m(2). Among patients with chronic kidney disease (CKD; baseline eGFR = 60 mL/minute/1.73 m(2)) at month 36. Only 20.9% and 17.4% among those converted beyond 12 months (late conversion) experienced improvement respectively at month 36 and 60. A logistic regression analysis in patients with CKD stage >= 3 demonstrated that late conversion, age, and female sex were associated with nonimprovement of eGFR (>= 60 mL/minute/1.73 m(2)). Data from this real-life use of EVR indicate that renal function was maintained from the preconversion period until month 36 even in patients with advanced CKD. However, early rather than late conversion appears to be a safe approach to preserve longterm renal function in LTRs.