Impact of tacrolimus versus cyclosporin A on renal function during the first year after heart transplant.
Impact of tacrolimus versus cyclosporin A on renal function during the first year after heart transplant.
复制标题
他克莫司与环孢素 A 对心脏移植后第一年肾功能的影响。
DOI：
10.1002/ehf2.12749
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发表时间：
2020
期刊：
影响因子：
3.8
通讯作者：
Komuro I
中科院分区：
文献类型：
--
作者：
Shiraishi Y;Amiya E;Hatano M;Katsuki T;Bujo C;Tsuji M;Nitta D;Maki H;Ishida J;Kagami Y;Endo M;Kimura M;Ando M;Shimada S;Kinoshita O;Ono M;Komuro I
钙调磷酸酶抑制剂（CNIs）的肾毒性与接受心脏移植（HTx）的患者的不良事件有关，尽管直接比较他克莫司（TAC）与环孢素A（CsA）的研究，特别是与依维莫司和低剂量CNIs方法联合使用的研究有限。因此，我们试图调查TAC和CsA与HTx受体的临床结局的关联，特别关注肾功能.Methods和resultsFrom 2007年8月至2017年2月，72例连续患者（39例接受TAC与33例CsA）在一个单一的移植中心receivingde novoHTx进行了回顾性评价。我们使用工具变量法来解释未测量的混杂因素。研究结局为HTx后第一年内估计肾小球滤过率（eGFR）（安全性终点）和活检证实的急性排斥反应（疗效终点）的百分比变化。入组患者（中位年龄40岁）主要为男性（68%）。除性别（男性，TAC组49% vs. CsA组91%;P< 0.001）外，两组基线特征无显著差异，包括eGFR（TAC组64.8 [45.7-96.4] mL/min/1.73 m2 vs. CsA组65.6 [57.9-83.0] mL/min/1.73 m2;P= 0.48）。在HTx后的第一年内，TAC组有23例（59%）将霉酚酸酯转换为依维莫司，而CsA组有16例（48%）（P= 0.52）。12个月时，死亡率和需要肾脏替代治疗的终末期肾病发生率均为0%。在工具变量分析中，TAC组和CsA组在HTx后1年的肾功能以及移植物排斥反应方面没有差异。这些结果是相似的，当考虑到依维莫司use. ConclusionsInregardless的依维莫司使用低剂量CNIs，我们的分析使用工具变量法显示，在HTx后的第一年，接受TAC或CsA的HTx受体之间的肾功能以及移植排斥反应没有差异。
AimsNephrotoxicity of calcineurin inhibitors (CNIs) is associated with adverse events in patients undergoing heart transplant (HTx), although studies directly comparing tacrolimus (TAC) versus cyclosporin A (CsA), especially in combination with everolimus and low‐dose CNIs approach, are limited. Thus, we sought to investigate the associations of TAC and CsA with clinical outcomes in HTx recipients, with specific focus on renal function.Methods and resultsFrom August 2007 to February 2017, 72 consecutive patients (39 treated with TAC vs. 33 with CsA) receivingde novoHTx in a single transplant centre were retrospectively evaluated. We used the instrumental variable method to account for unmeasured confounding. The study outcomes were percentage change in estimated glomerular filtration rates (eGFR) (safety endpoint) and biopsy‐proven acute rejection (efficacy endpoint) within the first year after HTx. The enrolled patients (median age 40 years) were predominantly men (68%). There were no significant differences in baseline characteristics, including eGFR (64.8 [45.7–96.4] mL/min/1.73 m2in TAC vs. 65.6 [57.9–83.0] mL/min/1.73 m2for CsA;P= 0.48), other than sex (male, 49% for TAC vs. 91% for CsA;P< 0.001) between the two groups. Within the first year after HTx, 23 (59%) in the TAC group switched mycophenolate mofetil to everolimus, whereas 16 (48%) in the CsA group (P= 0.52). At 12 months, the rates of mortality and end‐stage renal disease requiring renal replacement therapies were both 0%. In the instrumental variable analysis, no differences in renal function as well as graft rejection for 1 year after HTx existed between the TAC and CsA groups. These results were similar when taking into account of everolimus use.ConclusionsIrrespective of everolimus use with low‐dose CNIs, our analysis using the instrumental variable method showed no differences in renal function as well as graft rejection during the first year after HTx between HTx recipients who received TAC or CsA.