在肝移植中使用mycophenolate mofetil单疗法代替氨酸抑制剂的指示和长期结果
Carlos Jiménez-Romero1,2, Iago Justo Alonso1,2, Oscar Caso Maestro1,2
1Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain.
概括
从氨酸抑制剂转换为mycophenolate mofetil单疗法可以改善肝移植患者的功能. 这种切换被很好地容忍,排斥率低,功能改善,证明了它的有效性.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植医学 移植医学
- 免疫抑制是一种免疫抑制.
背景情况:
- 氨酸抑制剂 (CNIs) 是肝移植 (LT) 后的标准免疫抑制剂.
- 慢性病 (CKD) 和其他与CNI相关的不良影响 (糖尿病,高血压,感染) 需要替代免疫抑制策略.
- 菌酸莫菲蒂尔单疗法 (MMF-MT) 被认为是一个可行的替代方案.
研究的目的:
- 评估从基于CNI的免疫抑制转换为基于MMF的MT在LT接受者中具有CKD或CNI相关的不良影响的疗效和安全性.
- 评估MMF-MT对功能,不良事件和患者存活率的影响.
主要方法:
- 对324名从CNI转换为MMF-MT的LT患者的回顾性分析.
- 长期随访,MMF-MT的中位数为78个月.
- 在MMF-MT前和之后的功能 (GFR,肌素) 和肝酶 (ALT) 的比较,使用重复测量模型.
主要成果:
- 在MMF-MT后,GFR显著改善,肌素和ALT水平下降.
- 急性排斥率低 (7.4%) 和MMF-MT相关的不良反应率低 (14.8%),只有2.5%的患者停止使用MMF-MT.
- 在MMF-MT转换后的5年患者生存率为75.3%.
结论:
- MMF-MT是一种有效的策略,用于改善LT患者的功能,这些患者患有CKD或CNI相关的不良影响.
- 货币货币基金MT表现出良好的耐受性和低拒绝率,使其成为CNI的安全替代品.
- 切换到MMF-MT可以导致肝移植接受者改善长期结果.
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