小剂量环孢素A减轻西罗莫司导致的移植肾蛋白尿

背景:西罗莫司作为一种低肾毒性的免疫抑制剂越来越多地取代钙调神经抑制剂用于肾脏移植后,但蛋白尿是其最常见的不良反应之一,迄今为止尚无有效的治疗措施,这很大程度上制约了它的广泛使用。目的:观察小剂量环孢素A减轻西罗莫司导致的移植肾蛋白尿的效果和安全性。方法:24例采用以西罗莫司为基础的三联免疫抑制方案(西罗莫司+吗替麦考酚酯+皮质激素)出现蛋白尿的肾移植患者,10例加用小剂量环孢素A(25mg/d)的四联免疫方案患者(四联组)与14例维持原三联方案的患者(三联组),随访6个月。结果与结论:①四联组6个月后蛋白尿有显著下降(P<0.01),同时与三联组比较,差异也有显著性意义(P<0.05)。②两组肾小球滤过率比较,差异无显著性意义(P=0.10)。③三联组3例次泌尿生殖系感染,四联组发生3人6例次感染,其中1例次肺部感染,5例次泌尿生殖系感染。表明小剂量环孢素在不明显增加肾毒性和感染风险的情况下可以显著减少西罗莫司导致的肾移植后蛋白尿。

Low-dose cyclosporine A reduces sirolimus-associated proteinuria after kidney transplantation

BACKGROUND： Sirolimus has been proposed as a non-nephrotoxic alternative to calcineurin inhibitor for prevention of adverse reaction after kidney transplantation, proteinuria is one of the most significant adverse reactions. So far, there is no effective treatment measure, and it limits the use of this molecule. OBJECTIVE： To investigate the efficacy and safety of low-dose cyclosporine A in reducing the sirolimus-associated proteinuria after kidney transplantation. METHODS： This prospective study included 24 kidney transplant recipients who receiving sirolimus based tri-regimens immunosuppressed therapy （sirolimus＋mycophenolate mofetil＋cotical hormone） and suffering sirolimus-associated proteinuria. Low-dose cyclosporine （25mg/d） was added to the tri-regimens immunosuppression in 10 recipients （tetra-regimens group）, and the other 14 patients maintained the tri-regimens immonusuppression （tri-regimens group）. All the patients were followed-up for 6 months. RESULTS AND CONCLUSION： ①After 6 months follow-up, the content of proteinuria in the tetra-regimens group was significantly decreased （P 0.01）, and the difference was significant when compared with tri-regimens group （P 0.05）. ②There was no significant difference of the glomerular filtration rate between two groups （P=0.10）. There were three patients suffering from genitourinary tract infection in tri-regimens group, while three patients in tetra-regimens group suffered from six infectious episodes, one patient suffered from lung infection and five patients suffered from genitourinary tract infection. Low-dose cyclosporine can reduce sirolimus-associated proteinuria after kidney transplantation without serious nephrotoxicity and infectious side effects.