https://scholars.lib.ntu.edu.tw/handle/123456789/521495
標題: | Sirolimus add-on rescue therapy can benefit patients with chronic renal allograft dysfunction | 作者: | MENG-KUN TSAI CHIH-YUAN LEE REY-HENG HU PO-HUANG LEE |
公開日期: | 2003 | 卷: | 102 | 期: | 12 | 起(迄)頁: | 863-867 | 來源出版物: | Journal of the Formosan Medical Association | 摘要: | Background and Purpose: Nephrotoxicity caused by calcineurin inhibitors (CNIs) contributes to chronic renal allograft dysfunction (CRAD). This retrospective cohort study evaluated the immunosuppressive and nephrotoxic effects of sirolimus add-on therapy with minimization of CNI in patientse with CRAD. Methods: Twenty patients with CRAD were recruited to receive sirolimus add-on rescue (SRL-AR) therapy. The SRL-AR therapy added 6 mg of sirolimus for loading and 2 mg/day for maintenance immunosuppressive regimens and reduced the dose of CNI, either cyclosporine or tacrolimus, by half at the initiation of sirolimus loading. The primary endpoint of the study was estimated glomerular filtration rate (GFR) determined using the Cockcroft-Gault formula. The efficacy of this SRL-AR therapy was evaluated by comparison to a historic group of 30 patients with CRAD who received a tacrolimus-based rescure therapy. Results: Of the 20 patients receiving sirolimus therapy, 2 had graft failure during the 12-month follow-up. The post-rescue GFR values of the patients receiving sirolimus therapy showed greater improvement than those of the historic group during follow-up except for month 8, with the differences in GFR changes reaching significance at months 1 to 5 (p <0.05). Multiple regression analysis identified graft age and GFR upon rescue in addition to the SRL-AR therapy as significant factors associated with post-rescue GFR changes. Conclusions: This study demonstrated that SRL-AR therapy combined with reduced CNI doses could effectively improve short-term renal function of patients with CRAD. The long-term outcome of rescuing CRAD is likely to depend on factors including graft and GFR upon rescue. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-2342449417&partnerID=40&md5=ccb492a76bcf15623f4fd325198af136 https://scholars.lib.ntu.edu.tw/handle/123456789/521495 |
ISSN: | 0929-6646 | SDG/關鍵字: | calcineurin inhibitor; cyclosporin; lipid; liver enzyme; mycophenolic acid 2 morpholinoethyl ester; rapamycin; steroid; tacrolimus; add on therapy; adult; age; arthralgia; article; clinical article; cohort analysis; controlled study; dose response; drug dose reduction; drug efficacy; female; follow up; glomerulus filtration rate; graft failure; graft survival; herpes; Herpes virus; human; hyperlipidemia; immune deficiency; kidney allograft rejection; kidney disease; kidney failure; kidney function; kidney transplantation; leukopenia; liver dysfunction; maintenance therapy; male; pneumonia; regression analysis; retrospective study; treatment outcome; Adolescent; Adult; Child; Chronic Disease; Cohort Studies; Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Sirolimus |
顯示於: | 醫學系 |
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