Outcomes with conversion from calcineurin inhibitors to sirolimus after renal transplantation in the context of steroid withdrawal or steroid continuation.
Outcomes with conversion from calcineurin inhibitors to sirolimus after renal transplantation in the context of steroid withdrawal or steroid continuation.
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肾移植后在类固醇戒断或继续使用类固醇的情况下从钙调神经磷酸酶抑制剂转换为西罗莫司的结果。
DOI：
10.1097/tp.0b013e3181b27d44
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发表时间：
2009
期刊：
影响因子：
6.2
通讯作者：
Mandelbrot,DidierA
中科院分区：
文献类型：
--
作者：
Egbuna,OgoI;Davis,RogerB;Chudinski,Robyn;Pavlakis,Martha;Rogers,Christin;Molakatalla,Phani;Johnson,ScottR;Karp,Seth;Monaco,AnthonyP;Tang,Hongying;Hanto,DouglasW;Mandelbrot,DidierA
背景：许多研究表明，从钙调磷酸酶抑制剂（CNI）转换为西罗莫司（SRL）可以改善肾移植患者的移植物功能。这些研究都没有转换为SRL患者在没有steroids.Methods：我们描述了我们的经验与278例肾移植，其中153例从CNI转换为SRL。大多数患者在6天后停用类固醇。几乎所有的患者都接受了抗胸腺细胞球蛋白诱导，并维持在霉酚酸酯上。结果：转换后6个月，患者仍在使用SRL治疗，估计肾小球滤过率平均增加6.93 mL/min/1.73 m2（P< 0.0001）与转换前值相比。通过意向治疗分析，SRL转换患者的估计肾小球滤过率增加了5.00 mL/min/1.73 m2（P= 0.0005）。81%的患者在6个月时成功转换为稳定或改善的肾功能。尿蛋白/肌酐比值大于1是转复失败的唯一预测因素。SRL转换的益处在高免疫风险和低风险患者中均可见。6个月时蛋白尿平均增加0.1（P= 0.43）。36%的SRL转换患者经历了需要转换回CNI的不良反应。排斥反应，移植物丢失，和患者死亡率与SRL转换是low.Conclusions的结果，从我们的临床实践表明，即使在没有类固醇，SRL转换显着改善肾功能，可接受的不良事件率。
Background.A number of studies have suggested that conversion from calcineurin inhibitors (CNI) to sirolimus (SRL) can improve graft function in renal transplant patients. None of these studies has converted patients to SRL in the absence of steroids.Methods.We describe our experience with 278 renal transplants of which 153 were converted from CNI to SRL. The majority of patients had steroids withdrawn after 6 days. Almost all patients received antithymocyte globulin induction and were maintained on mycophenolate mofetil.Results.Six months after conversion, patients remaining on SRL therapy had a mean increase in estimated glomerular filtration rate of 6.93 mL/min/1.73 m 2 (P< 0.0001) compared with preconversion values. SRL-converted patients analyzed by intention-to-treat increased estimated glomerular filtration rate by 5.00 mL/min/1.73 m 2 (P= 0.0005). Eighty-one percent of patients remaining on SRL had a successful conversion, defined as stable or improved renal function at 6 months. The only factor predictive of unsuccessful conversion was urine protein-to-creatinine ratio more than 1. The benefits of SRL conversion were seen in patients at high immunological risk as well as those at lower risk. Proteinuria increased by a mean of 0.1 (P= 0.43) at 6 months. Thirty-six percent of SRL-converted patients experienced adverse effects requiring conversion back to CNI. Rates of rejection, graft loss, and patient death with SRL conversion were low.Conclusions.The results from our clinical practice suggest that even in the absence of steroids, SRL conversion significantly improves renal function, with acceptable rates of adverse events.