Calcineurin Inhibitor Sparing in Renal Transplantation
Calcineurin Inhibitor Sparing in Renal Transplantation
复制标题
肾移植中钙调神经磷酸酶抑制剂的保留
DOI：
10.1097/tp.0b013e3181856f39
复制
发表时间：
2008
期刊：
影响因子：
6.2
通讯作者：
H. Ekberg
中科院分区：
文献类型：
--
作者：
H. Ekberg
尽管钙调磷酸酶抑制剂（CNIs）在预防急性排斥反应方面是有效的，但它们的长期使用与肾毒性有关，可能损害同种异体肾移植的长期生存。因此，有相当大的兴趣确定免疫抑制方案，允许减少暴露于cni，同时保持足够的免疫抑制。移植后早期引入此类策略可能意味着cni相关肾毒性的发展可以最小化或预防。几种CNI保护方案显示出至少与标准剂量CNI方案相当的疗效。特别地，从移植时开始使用霉酚酸酯（MMF）、皮质类固醇、白细胞介素-2受体拮抗剂诱导和低剂量他克莫司的方案比使用低剂量环孢素或低剂量西罗莫司或标准剂量环孢素、MMF和皮质类固醇的相同方案提供了更好的肾功能和更低的急性排斥率。使用低剂量环孢素似乎不能消除新肾移植受者的肾毒性。早期退出以mmf为基础的方案的cni通常会改善肾功能，但与急性排斥反应的风险增加有关，特别是当霉酚酸的水平没有调整到维持相同的免疫抑制总水平时。旨在实现现有免疫抑制方案的疗效和毒性“最佳”平衡的研究仍在继续。
Although calcineurin inhibitors (CNIs) are effective at preventing acute rejection, their long-term use is associated with nephrotoxicity that may compromise long-term renal allograft survival. Consequently, there is considerable interest in identifying immunosuppressive regimens that permit reduced exposure to CNIs while maintaining adequate immunosuppression. Introducing such strategies early after transplantation may mean that the development of CNI-associated nephrotoxicity could be minimized or prevented. Several CNI-sparing regimens have shown at least comparable efficacy with standard-dose CNI regimens. In particular, a regimen of mycophenolate mofetil (MMF), corticosteroids, interleukin-2 receptor antagonist induction, and low-dose tacrolimus from the time of transplantation provided superior renal function and a lower acute rejection rate than the same regimen but with low-dose cyclosporine or low-dose sirolimus, or standard-dose cyclosporine, MMF, and corticosteroids. The use of low-dose cyclosporine does not seem to eliminate nephrotoxicity in de novo renal transplant recipients. The early withdrawal of CNIs from MMF-based regimens generally improves renal function but has been associated with an increased risk of acute rejection, in particular when the levels of mycophenolic acid were not adjusted to maintain the same total level of immunosuppression. Research aiming to achieve the “best” balance of efficacy and toxicity of available immunosuppressive regimens continues.