他克莫司从每日两次改为每日一次可改善移植肾功能,但对肾移植受者蛋白尿无影响

N. Bašić-Jukić, L. Bubić-Filipi, L. Katalinic, Judita Lelas
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引用次数: 0

摘要

摘要介绍。他克莫司缓释制剂可每日一次使用。虽然越来越多的患者已经从每日两次(Tac- BID)转变为每日一次(Tac-QD)制剂,但有关Tac-QD的起始和随访的可用信息很少。在本研究中,我们研究了从Tac-BID或环孢素切换到Tac-QD对同种异体肾功能、蛋白尿和蛋白肌酐(P/C)比的影响。方法。2012年10月至2014年10月,129例肾移植受者(女性38%,平均年龄49岁)在移植后不同时间从Tac-BID或环孢素转为他克莫司缓释制剂。重点分析移植物功能指标(GFR、血清肌酐、蛋白尿、P/C比)、肝功能指标(AST、ALT、γ - gt、碱性磷酸酶)和血糖。分别在基线(转换前)、转换后1个月(V1)、6个月(V6)和12个月(V12)获得临床资料。结果。血清肌酐和GFR均有统计学意义的改善。对于GFR,早在V1时就观察到显著改善,并在整个研究期间持续增加直至V12(所有两次访问之间的变化均具有统计学意义)。在整个随访期间,血清肌酐的平均水平在数值上呈下降趋势,但在V6时有显著改善,在V12时仍有显著改善(均与V0值相比)。蛋白尿和P/C在观察期间无明显变化。多数患者AST、ALT、GGT、AlP、葡萄糖基线值均在正常范围内,观察期内无明显变化。他克莫司C0的分析显示,在整个随访期间,几乎在所有访问中都有显著下降。这一发现与他克莫司剂量从基线到V6和V12的显著下降以及他克莫司剂量/体重的显著下降相一致。结论。环孢素或Tac-BID转化为缓释Tac-QD可改善肾移植受者的移植物功能,而不影响蛋白尿或P/C比值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Conversion from Twice-Daily to Once-Daily Tacrolimus Improves Graft Function but has no Influence on Proteinuria in Renal Transplant Recipients
Abstract Introduction. Tacrolimus extended-release formulation enables once-daily use. Although an increasing number of patients have been converted from twice-daily (Tac- BID) to once-daily (Tac-QD) formulation, the available information regarding the initiation and follow-up of Tac- QD is sparse. In the present study we investigated influence of switch from Tac-BID or cyclosporine to Tac-QD on renal allograf function, proteinuria and protein-creatinine (P/C) ratio. Methods. Between October 2012 and October 2014, the switch from Tac-BID or cyclosporine to tacrolimus extended-release formulation was done in 129(38% female, mean age 49 years) renal transplant recipients at different time after transplantation. The analysis focused on markers of graft function (GFR, serum creatinine, proteinuria, P/C ratio), liver function (AST, ALT, γGT, alkaline phosphatase) and blood glucose. Clinical data were obtained at baseline (before conversion), 1 month (V1), 6 months (V6) and 12 months (V12) after conversion. Results. Both serum creatinine and GFR showed a statistically significant improvement. With GFR, signifycant improvement was observed as early as V1 and it continued to increase throughout the study period up to V12 (all between-visit changes were statistically significant). With serum creatinine, mean levels were numerically decreasing throughout the follow-up period, but a significant improvement occurred at V6 and remained significant at V12 (both vs. V0 values). Proteinuria and P/C ratio did not show any significant change through the observation period. In the majority of patients, the baseline values of AST, ALT, GGT, AlP and glucose were within normal limits and did not change significantly through the observation period. Analysis of tacrolimus C0 showed a significant decrease throughout the follow-up period, at practically all visit. This finding was paralleled by a significant tacrolimus dose decrease from baseline to V6 and V12, as well as by a significant decrease of tacrolimus dose/body weight. Conclusions. Conversion from cyclosporine or Tac-BID to extended-release Tac-QD improves graft function in renal transplant recipients, without influence on proteinuria or P/C ratio.
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