Outcomes of mTORi-involving minimized immunosuppression protocols in renal transplantation

Abstract

Amaç Böbrek alıcılarında sitomegalovirüs (CMV), poliyoma B-K virüs (BKV) ve kalsinörün inhibitörü (KNİ) toksisitesi ve malignite geliştiğinde immünosupresyonu azaltmak gerekir. İmmünosupresyon azaltma protokolleri genellikle standart doz KNİ’nin azaltılması ve bir mTORi eklenmesini içerir. Bu çalışmada standart bir immünsupresyon protokolünden mTORi içeren düşük immünosupresyon protokolüne geçtikten sonra ki greft fonksiyonlarını incelemeyi amaçladık. Metod Bu tek-merkezli, retrospektif ve gözlemsel çalışma 2014-2016 yılları arasında yapılmış böbrek nakillerinin sonuçlarını içermektedir. Toplan 322 alıcı incelendi ve bunların 231’i çalışmaya alındı. En az 12 ay mTORi alanlar mTORi kolunda değerlendirildi. CMV ve BKV test sonuçları ve hiç greft biyopsisi olmayan alıcılar çalışma dışı bırakıldı. Geriye kalan alıcılar mTORi içermeyen gurubu oluşturdu. mTORi öncesi ve mTORi sonrası birinci ve üçüncü yıl greft sağkalımları ve fonksiyonları karşılaştırıldı. Sonuçlar Toplam 231 alıcı ortalama 5 yıl takip edildi. mTORi kolunda CMV ve BKV pozitifliği daha sıktı (p=0,001). Ayrıca, mTORi kolunda akut rejeksiyon sıklığı daha fazlaydı; p=0,001. Tahmini glomerüler filtrasyon hızı (tGFH) mTORi sonrası birinci ve üçüncü yılda daha azdı (p=0,001). Ancak, mTORi sonrası birinci ve üçüncü yıl greft sağ kalım oranları mTORi kullanmayanlar ile benzerdi (p=0,52 ve p=0,72, sırasıyla). Sonuç Böbrek alıcılarında mTORi, genellikle immünsupresyon dozunun azaltılmak zorunda olduğu durumlarda (CMV ve BKV viremisi varlığı, KNİ ilişkili nefrotoksisite gibi) düşük doz KNİ’ler ile birlikte kullanılır. Tüm dezavantajlara rağmen mTORi standart protokollere benzer greft sağkalımı sağlayabilir. Ancak, mTORi kullanımı daha fazla akut rejeksiyon ile ilişkilidir ve tGFH’da azalmayı engelleyemeyebilir.

Keywords

• Renal allograft
• mTORi
• renal transplantation

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