腎機能不全の肝臓移植患者でカルシネウリン阻害剤をミコフェノラートモフェチルに置き換える:ランダム化制御試験
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
まとめ
カルシネウリン阻害剤 (CNI) からミコフェノラートモフェチルに切り替えると,肝移植患者の腎臓機能と血圧が改善された. しかし,この変化は,移植拒絶のリスクを高めました.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 移植医療 移植医療について
- 免疫抑制は免疫を抑制する.
背景:
- 肝臓移植を受けた患者の長期カルシネウリン阻害剤 (CNI) 治療は,しばしば腎臓機能不全を引き起こす.
- 移植後の合併症の管理において,ミコフェノラートモフェチルによるCNIの代替の安全性と有効性の評価は極めて重要です.
研究 の 目的:
- 肝臓移植患者の腎臓機能に対するカルシネウリン阻害剤 (CNI) をマイコフェノラートモフェチルで代用する影響を評価する.
- この免疫抑制薬の安全性と有効性を評価するために,レジメンの変更.
主な方法:
- 腎機能不全の肝臓移植を受けた28人を対象としたランダム化研究.
- 患者は2つのグループに分けられ,1つのグループはCNIをmycophenolate mofetilで置き換えたが,対照群はCNI治療を継続した.
- 腎機能,血圧,尿酸,血脂,移植機能は6ヶ月間モニタリングされた.
主要な成果:
- ミコフェノラートモフェチル群の血清クレアチニン濃度は,対照群と比較して有意に低下した (平均差は41.3マイクロモール/L).
- シストリックおよびダイアストリック血圧,血清の尿酸も研究グループで有意な減少を示しました.
- ミコフェノラートモフェチル群では急性移植拒絶のエピソードが3回発生したが,対照群では発生しなかった.
結論:
- CNIをミコフェノラートモフェチルに置き換えると,腎機能が向上し,血圧が低下し,肝移植患者の尿酸レベルが低下する.
- マイコフェノラートモフェチルの単独治療は,急性移植拒絶の危険性が高くなります.
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