雷帕鸣对肾移植有多大效果？

Rapamin (sirolimus tablets) is a powerful immunosuppressant that not only has less nephrotoxicity, anti-proliferation, and anti-tumor effects, but can also reduce adverse reactions such as liver and kidney toxicity and serious infections in kidney transplant recipients. Kidney transplant recipients may also benefit from treatment with the drug.

In order to verify the effectiveness and safety of sirolimus conversion treatment when one or more risk factors occur in the calcineurin inhibitor-based immunosuppressive regimen, a domestic experiment included 93 patients who were converted to sirolimus-based immunosuppressive treatment after kidney transplantation. There were 59 males and 34 females, aged (38±11) years old.

The treatment plan for all patients adopts a rapid conversion method, that is, the calcineurin inhibitor is removed within 2 weeks, and 4 hours after oral administration of cyclospora A or tacrolimus, sirolimus is administered orally, with a single first loading dose of 6 mg, and then a maintenance dose of 1.0 to 2.0 mg/d. The first sirolimus concentration is measured 5 to 7 days after taking the first dose of sirolimus, and the target mass concentration is 6 to 10 μg/L.

The results showed that after sirolimus conversion therapy, the symptoms of patients with calcineurin-inhibited nephrotoxicity and hepatotoxicity improved significantly, the blood concentration was maintained at (5.1±1.2) μg/L, and the serum creatinine dropped from (297.72±150.28) μmol/L to (123.76±44.2) μmol/L. Liver function recovered after the conversion (24 cases, 92.3%). Nine cases of hyperglycemia patients returned to normal and 2 cases improved: 17 cases had a decrease in serum creatinine greater than 25% of the original creatinine level, and the effective rate was 51.5%; 10 cases of tumors occurred 6 to 43 months after kidney transplantation, and 8 cases were stable without recurrence. Three cases of acute rejection occurred within 6 months of telolimus conversion therapy. The 3-year human kidney survival rates after conversion therapy were 90.9% and 75.8% respectively.

CONCLUSIONS: When kidney transplant recipients taking calcineurin inhibitors develop one or more risk factors, switching to an immunosuppressive regimen of rapamycin and mycophenolate mofetil reduces adverse effects.