Conversion to sirolimus with calcineurin inhibitor elimination vs. dose minimization and renal outcome in heart and lung transplant recipients

被引：17
作者：
Demirjian, S. [1 ]
Stephany, B. [1 ]
Abu Romeh, I. S. [2 ]
Boumitri, M. [2 ]
Yamani, M. H. [3 ]
Poggio, E. D. [1 ]
机构：
[1] Cleveland Clin, Dept Hypertens & Nephrol, Cleveland, OH 44195 USA
[2] Cleveland Clin, Dept Internal Med, Cleveland, OH 44195 USA
[3] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44195 USA
来源：
CLINICAL TRANSPLANTATION | 2009年 / 23卷 / 03期
关键词：
calcineurin inhibitor; cyclosporine; heart transplantation; kidney disease; lung transplantation; sirolimus; tacrolimus; CHRONIC ALLOGRAFT DYSFUNCTION; EARLY CYCLOSPORINE WITHDRAWAL; MYCOPHENOLATE-MOFETIL; FREE IMMUNOSUPPRESSION; RANDOMIZED MULTICENTER; FOLLOW-UP; DE-NOVO; RECOVERY; NEPHROTOXICITY; PROTEINURIA;
D O I：
10.1111/j.1399-0012.2009.00963.x
中图分类号：
R61 [外科手术学];
学科分类号：
摘要：
Sirolimus (SRL) has been used as an alternative immunosuppressant strategy to allow either dose minimization or complete withdrawal of calcineurin inhibitors (CNI) therapy to improve renal outcome. One hundred thirty-one heart and 55 lung transplant patients were converted from a CNI to SRL based immunosuppression, with CNI elimination in 25 patients, and dose reduction in 161 patients. Fifty-six (28%) patients died and 65 (33%) patients had a 25% or more decline in estimated glomerular filtration rate (eGFR) during a median follow-up of 18 months. The three groups (SRL only group n = 25; SRL + tacrolimus n = 94; SRL + cyclosporine n = 67) had an initial improvement in estimated glomerular filtration rate (p = 0.05), with subsequent similar slow decline in mean eGFR (repeated measures ANOVA, p = 0.96). After controlling for important potential confounding variables, the three groups had similar renal outcome (p = 0.40) and overall survival (p = 0.45). In conclusion, the benefits of CNI withdrawal vs, minimization as part of SRL-based regimens are similar with regard to renal outcomes and patient survival.
引用
收藏
页码：351 / 360
页数：10
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