Renal Transplantasyonda Kalsinörin İnhibitörlerinden mTOR İnhibitörlerine Geçiş: Tek Merkez Deneyimi

Conversion from Calcineurin Inhibitors to mTOR inhibitors in Renal Transplantation: A Single Centre Experience

Seyit İbrahim AKDAĞ, Tolga YILDIRIM, Özlem YAYAR, Zafer ERCAN, Özgür MERHAMETSİZ, Ebru OĞUZ GÖK, Güner GÜRSOY KARAVELİ, Ayhan HASPULAT, Deniz AYLI, Hadim AKOĞLU

Abstract

OBJECTIVE: Mammalian target of rapamycin (mTOR) inhibitors are among the immunosuppressive drugs used in renal transplantation. The aim of this study was to reveal our experiences in conversion from calcineurin inhibitors (CNI) to mTOR inhibitors in 20 renal transplant patients. MATERIAL and METHODS: Various protocols were used in the conversion from CNIs to mTOR inhibitors. CNIs were discontinued and mTOR inhibitors were initiated in patients with malignancy. In cases of CNI toxicity and in cases in which conversion was performed for other causes, reduced doses of CNIs were administered for three days in combination with mTOR inhibitors. RESULTS: The study included 20 renal transplant patients, of whom 14 were male and 6 were female. The mean age of the patients was 43.5±8.8 years. The reason for conversion was CNI toxicity in 16 patients (80%), malignancy in 3 patients (15%), and premalignant lesion in 1 patient (5%). Conversion to mTOR inhibitors [(sirolimus (n=14) and everolimus (n=6)] was performed at 62.6±45.7 months after transplantation. The mean follow-up period after administration of mTOR inhibitors was 50.5±29.9 months. The mean proteinuria at the time of conversion was 227.5±147.9 mgr/day and increased to 636.5±388.2 mgr/day after treatment with mTOR inhibitors (p

Özet

AMAÇ: mTOR inhibitörleri (mTOR i) renal transplantasyonda tercih edilen immünsupresiflerdendir. Bu çalışmada, kalsinörin inhibitörleri (KNI) kesilerek mTOR inin başlandığı, 20 olgudan oluşan, böbrek nakilli hastalardan elde ettiğimiz deneyimler sunulacaktır. GEREÇ ve YÖNTEMLER: KNIdan mTOR iye geçiş protokolünde farklı yöntemler uygulanmıştır. Maligniteli hastalarda KNI birden kesilerek mTOR iye başlanırken KNI toksisitesi olan ve diğer nedenlerle dönüşüm yapılan olgularda ise KNI dozu azaltılarak mTOR i ile birlikte 3 gün verilmiştir. BULGULAR: Renal transplantlı 20 hastanın yaş ortalaması 43,5±8,8 yıl olup; 14 erkek 6 kadın hastadan oluşuyordu. Geçiş nedenleri; maligniteler ( n=3, %15), KNI toksitesi (n=16, %80) ve premalign lezyon (n=1 %5) idi. mTOR iye geçiş (14 hasta sirolimus, 6 hasta everolimus) transplantasyondan ortalama 62,6±45,7 ay sonra yapıldı. mTOR i sonrası ortalama takip süresi 50,5±29,9 aydır. Tedavi değişimi sırasında proteinüri miktarı ortalama 227,5±147,9 mgr/gün iken, mTOR i tedavisi sonrası bu değer artarak ortalama 636,5±338,2 mgr/gün oldu (p