mTOR抑制剂对肺移植候选名单中淋巴管瘤病患者死亡率和安全性的影响:回顾性队列研究

IF 2.4 Q2 RESPIRATORY SYSTEM
Teiko Sakurai , Takashi Kanou , Soichiro Funaki , Eriko Fukui , Toru Kimura , Naoko Ose , Yoshikazu Inoue , Yasushi Shintani
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引用次数: 0

摘要

背景虽然肺移植(LTx)是终末期淋巴管瘤病(LAM)患者的最后手段,但在日本,高等待死亡率令人担忧。由于严重不良反应的发生率较高,因此建议在LTx前停用雷帕霉素机制靶点(mTOR)抑制剂。因此,我们推测mTOR抑制剂可能会影响LTx候补名单上的LAM患者的死亡率。方法我们回顾性比较了LTx候补名单上连续接受和未接受mTOR抑制剂治疗的LAM患者的特征。17名患者(58.6%)正在接受mTOR抑制剂西罗莫司治疗(治疗组)。在1277天的中位列表期内,12名患者(41.4%)住院治疗,6名患者(20.7%)在LTx治疗前死于疾病,15名患者接受了LTx治疗。在死亡患者中,4 名患者(66.6%)患有气胸。治疗组的候诊死亡率明显低于非治疗组(P = 0.03)。在治疗组停用西罗莫司的六名患者中,有四名患者(66.6%)在停用西罗莫司后因呼吸系统并发症住院治疗。接受LTx的治疗组(n = 7)中没有出现与mTOR抑制剂相关的并发症,包括西罗莫司剂量减少的患者。由于在LTx前停用西罗莫司后会发生危及生命的事件,因此在LTx前减少西罗莫司的剂量是允许的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of mTOR inhibitors on the mortality and safety of patients with lymphangioleiomyomatosis on the lung transplantation waitlist: A retrospective cohort study

Background

Although lung transplantation (LTx) is the last resort for patients with end-stage lymphangioleiomyomatosis (LAM), the high waitlist mortality is a source of concern in Japan. Discontinuation of mechanistic target of rapamycin (mTOR) inhibitors prior to LTx is recommended due to the incidence of severe adverse events. Therefore, we hypothesized that mTOR inhibitors may affect the mortality of patients with LAM on the LTx waitlist.

Methods

We retrospectively compared the characteristics of consecutive patients with LAM on the LTx waitlist who were and were not receiving mTOR inhibitors.

Results

Twenty-nine consecutive patients with LAM who listed our center between January 2004 and December 2021 were selected from the database and enrolled in the present study. Seventeen patients (58.6%) were receiving a mTOR inhibitor, sirolimus (treatment group). During a median listing period of 1277 days, 12 patients (41.4%) were hospitalized, six patients (20.7%) died from disease before LTx, and 15 patients underwent LTx. Among the deceased patients, four patients (66.6%) had pneumothoraces. The waitlist mortality in the treatment group was significantly lower than that in the non-treatment group (p = 0.03). Among the six patients who discontinued sirolimus in the treatment group, four patients (66.6%) were hospitalized with respiratory complications after the discontinuation of sirolimus. No mTOR inhibitor-related complications arose in the treatment group undergoing LTx (n = 7), including those on a reduced sirolimus dose.

Conclusions

Administration of an mTOR inhibitor until LTx may decrease waitlist mortality. Due to life-threatening events after discontinuing sirolimus pre-LTx, a reduced dose until LTx is permissible.

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来源期刊
Respiratory investigation
Respiratory investigation RESPIRATORY SYSTEM-
CiteScore
4.90
自引率
6.50%
发文量
114
审稿时长
64 days
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