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Sustitución de inhibidores de la calcineurina con micofenolato mofetil en pacientes trasplantados de hígado con
H J Schlitt1, A Barkmann, K H Böker
1Klinik für Viszeral und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany. schlitt.hans@mh-hannover.de
Lancet (London, England)
|September 18, 2001
Resumen
El cambio de inhibidores de la calcineurina (CNI) a micofenolato de mofetil mejoró la función renal y la presión arterial en pacientes con trasplante de hígado. Sin embargo, este cambio aumentó el riesgo de rechazo del injerto.
Área de la Ciencia:
- Nefrología Nefrología.
- Medicina del trasplante Medicina del trasplante.
- La inmunosupresión es la inmunodepresión.
Sus antecedentes:
- La terapia a largo plazo con inhibidores de la calcineurina (CNI) en receptores de trasplante de hígado con frecuencia conduce a disfunción renal.
- La evaluación de la seguridad y eficacia de la sustitución de los INC por micofenolato de mofetil es crucial para el manejo de las complicaciones posteriores al trasplante.
Objetivo del estudio:
- Evaluar el impacto de la sustitución de inhibidores de la calcineurina (CNI) por micofenolato de mofetil en la función renal en pacientes trasplantados de hígado.
- Para evaluar la seguridad y eficacia de este cambio de régimen inmunosupresor.
Principales métodos:
- Un estudio aleatorizado que involucró a 28 receptores de trasplante de hígado con disfunción renal.
- Los pacientes se dividieron en dos grupos: en un grupo se reemplazaron los INC con micofenolato de mofetil, mientras que el grupo de control continuó el tratamiento con INC.
- La función renal, la presión arterial, el ácido úrico, los lípidos sanguíneos y la función del injerto fueron monitoreados durante 6 meses.
Principales resultados:
- Los niveles de creatinina sérica disminuyeron significativamente en el grupo de micofenolato mofetil en comparación con los controles (diferencia media de 41,3 micromol/L).
- La presión arterial sistólica y diastólica y el ácido úrico sérico también mostraron reducciones significativas en el grupo de estudio.
- Tres episodios de rechazo agudo del injerto ocurrieron en el grupo de micofenolato mofetil, mientras que ninguno se observó en el grupo de control.
Conclusiones:
- La sustitución de los NIC por micofenolato de mofetil puede mejorar la función renal, disminuir la presión arterial y reducir los niveles de ácido úrico en pacientes con trasplante de hígado.
- La monoterapia con micofenolato mofetil se asocia con un riesgo elevado de rechazo agudo del injerto.
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