扩大标准供者肾移植西罗莫司四联方案的转换治疗同供者对照研究

A comparative study on the conversion treatment of the sirolimus quadruple regimen for expanded criteria donor kidney transplantation versus the control group from the same donors

    摘要
  • 摘要:
    目的  探讨扩大标准供者（ECD）供肾移植术后3 ~ 6个月将免疫抑制药三联方案他克莫司（Tac）＋吗替麦考酚酯（MMF）＋泼尼松（Pred）转换为低剂量西罗莫司（SRL）+低剂量Tac + MMF + Pred四联方案的有效性与安全性。
    方法  单中心、回顾性、同供者对照研究纳入2021年9月至2024年6月22例ECD供肾移植受者，来自同一供者供肾的2例受者分别作为SRL组与常规三联方案对照组。主要观察指标为两组转换前、转换后1、3、6、12个月血清肌酐（Scr）、估算肾小球滤过率（eGFR）及不良事件发生情况的差异。
    结果  两组受者基线特征差异均无统计学意义。SRL组自转换后3个月起Scr下降、eGFR升高，6个月起优于对照组（均为P＜0.05）。两组受者转换后随访12个月排斥反应、肺部感染、高脂血症及蛋白尿发生率差异均无统计学意义（均为P＞0.05）。
    结论  ECD供肾移植受者术后3 ~ 6个月将三联方案转换为SRL四联方案可在不增加不良事件发生风险的前提下改善移植肾功能。

     

    Abstract:
    Objective  To explore the efficacy and safety of converting the triple immunosuppressive regimen of tacrolimus (Tac) + mycophenolate mofetil (MMF) + prednisone (Pred) to a quadruple regimen of low-dose sirolimus (SRL) + low-dose Tac + MMF + Pred at 3 to 6 months after expanded criteria donor (ECD) kidney transplantation.
    Methods  A single-center, retrospective, donor-matched controlled study included 22 ECD kidney transplant recipients from September 2021 to June 2024. Two recipients from the same donor kidney were respectively assigned to the SRL group and the conventional triple regimen control group. The main outcome measures were the differences in serum creatinine (Scr), estimated glomerular filtration rate (eGFR), and adverse events before and after the regimen conversion at 1, 3, 6, and 12 months.
    Results  There were no statistically significant differences in baseline characteristics between the two groups. In the SRL group, Scr decreased and eGFR increased starting from 3 months after conversion, and this was superior to the control group starting from 6 months(all P < 0.05). There were no statistically significant differences in the incidence of rejection reactions, pulmonary infections, hyperlipidemia and proteinuria between the two groups after conversion and during the 12-month follow-up (all P > 0.05).
    Conclusions  For ECD kidney transplant recipients, converting the triple regimen to the SRL quadruple regimen at 3 to 6 months after transplantation may improve the function of the transplanted kidney without increasing the risk of adverse events.

     

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