Early renal benefit of rapamycin combined with reduced calcineurin inhibitor dose in pediatric heart transplantation patients
Early renal benefit of rapamycin combined with reduced calcineurin inhibitor dose in pediatric heart transplantation patients
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DOI：
10.1016/j.healun.2006.01.004
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发表时间：
2006-05-01
影响因子：
8.9
通讯作者：
Ferdman, Barbara R.
中科院分区：
文献类型：
--
作者：
Balfour, Ian C.;Srun, Sopheak W.;Ferdman, Barbara R.
背景：钙调神经磷酸酶抑制剂如环孢霉素可有效预防实体器官移植受者的排斥反应。不幸的是，长期使用钙调磷酸酶抑制剂可能会导致进行性renal injury.Methods：我们研究了15名儿童心脏移植受者谁正在服用钙调磷酸酶抑制剂的肾功能。在将雷帕霉素引入免疫抑制方案之前和之后，研究了他们的肾功能。随着雷帕霉素的引入，患者给予了较低剂量的钙调磷酸酶抑制剂，钙调磷酸酶抑制剂在5 patients.Results：肾功能显着改善后30天，这些变化的钙调磷酸酶抑制剂剂量制定的患者。平均血尿素氮和平均血清肌酐水平降低，平均肌酐清除率升高。雷帕霉素治疗前，患者的平均血尿素氮水平为27.1 +/- 12.4 mg/dl，雷帕霉素治疗后降至18.6 +/- 11.1 mg/dl（p = 0.014）。同样，肌酐从1.0 +/- 0.5 mg/dl降至0.8 +/- 0.3 mg/dl（P = 0.019）。他们的肌酐清除率从88 +/- 28 ml/min/1.73 mol/L（2）增加到105 +/- 27 ml/min/1-73 mol/L（2）（p = 0.008）。患者的脂质水平在服用雷帕霉素后没有变化。活检阴性排斥反应发展在2 patients.Conclusions：雷帕霉素的免疫抑制方案的患者服用钙调磷酸酶抑制剂，伴随着钙调磷酸酶抑制剂剂量的减少，可能会改善肾功能在30天内，没有显着增加排斥反应。
Background: Calcineurin inhibitors such as cyclosporine are effective in preventing rejection in recipients of solid organ transplants. Unfortunately, the prolonged use of calcineurin inhibitors may result in progressive renal injury.Methods: We studied the renal function of 15 pediatric heart transplant recipients who were taking calcineurin inhibitors. Their renal function was studied before and after rapamycin was introduced to their immunosuppression regimen. With the introduction of rapamycin, the patients were given a lower dose of calcineurin inhibitors, and the calcineurin inhibitor was discontinued in 5 patients.Results: Renal function improved significantly in the patients by 30 days after these changes in the calcineurin inhibitor dose were instituted. Mean levels of blood urea nitrogen and mean serum creatinine decreased, and mean creatinine clearance increased. Pre-rapamycin, the patients' mean level of blood urea nitrogen was 27.1 +/- 12.4 mg/dl and post-rapamycin they decreased to 18.6 +/- 11.1 mg/dl (p = 0.014). Similarly, creatinine decreased from 1.0 +/- 0.5 mg/dl to 0.8 +/- 0.3 mg/dI (P = 0.019). Their creatinine clearance increased from 88 +/- 28 ml/min/1.73 mol/liter(2) to 105 +/- 27 ml/min/1-73 mol/liter(2) (p = 0.008). The patients' lipid levels did not change after they were prescribed rapamycin. Biopsy-negative rejection developed in 2 patients.Conclusions: The introduction of rapamycin to the immunosuppressive regimen of patients taking calcineurin inhibitors, with a concomitant reduction of the calcineurin inhibitor dose, may improve renal function within 30 days, without a significant increase in rejection.