sirolimus治疗肾移植的效果如何？

Rapamin (sirolimus tablets) is an immunosuppressant whose non-nephrotoxicity has been confirmed by a series of clinical trials. Its emergence provides the possibility of reducing or even eliminating CsA. So, what is the effect of using it to treat kidney transplantation?

The unique mode of immunosuppression of sirolimus is that it blocks the late-stage proliferation reaction of T lymphocyte activation, inhibits cells from entering the S phase from G1 phase, blocks the binding of interleukin-2 (IL-2) to its receptor, and prevents Tc and Td cells from becoming sensitized T lymphocytes with immune response and exerting their immune effects.

Through its unique immune mechanism, sirolimus can often produce synergistic effects when used in combination with other immunosuppressants, and has the dual purpose of reducing its toxicity and improving efficacy. Sirolimus inhibits the activity of mTOR enzyme and has an inhibitory effect on the proliferation of T cells, B cells, mast cells, smooth muscle cells and fibroblasts. At the same time, by inhibiting PDGF, B-FGF, TGF-B and other cytokines, it reduces vasoconstriction and interstitial fibrosis, thereby slowing down the pathological changes of the kidney and improving the patient's renal function.

At present, laboratory studies and clinical observations show that sirolimus not only produces immunosuppression, but also has anti-proliferative and anti-tumor effects. Therefore, in patients with CAN or tumors after kidney transplantation, sirolimus has become a good alternative drug for withdrawing CNI-based regimens.

In a study conducted in China, patients' renal function improved after switching therapy. The results suggest that sirolimus is more effective than FK506 in switching treatments. The immunosuppressive treatment regimen based on sirolimus is safe and effective for patients with progressive increase in serum creatinine caused by the use of FK506. However, regarding the differences in medication between individuals, how to choose a more reasonable individualized treatment plan for each patient remains to be further explored.