Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Mối liên hệ giữa nồng độ tacrolimus trong huyết tương và tổn thương thận ở bệnh nhân ghép tim
Tóm tắt
Tổn thương thận cấp (AKI) thường được quan sát thấy sau khi ghép tim và liên quan đến tỷ lệ bệnh tật và tử vong. Tuy nhiên, nhiều yếu tố gây nhiễu khác cũng góp phần vào sự phát triển của AKI ở bệnh nhân ghép tim. Chúng tôi giả thuyết rằng nồng độ tacrolimus trong huyết tương vượt mức điều trị liên quan đến AKI. Trong một nghiên cứu quan sát hồi cứu từ tháng 4 năm 2005 đến tháng 12 năm 2012, tất cả các bệnh nhân ghép tim người lớn được bao gồm. Tổn thương thận cấp được đánh giá trong 2 tuần đầu sau khi ghép theo phân loại của Mạng lưới Cải thiện Kết quả Bệnh thận Toàn cầu (KDIGO). Nồng độ tacrolimus trong huyết tương được xác định từ ngày 1 đến ngày 14 và ở 1, 3, 6 và 12 tháng sau ghép. Phạm vi điều trị là 9 đến 15 ng/ml trong 2 tháng đầu và giảm xuống 5-8 ng/ml sau đó. Mối quan hệ giữa nồng độ tacrolimus vượt mức điều trị và AKI được đánh giá. Tác động của các yếu tố gây nhiễu tiềm ẩn khác lên nồng độ tacrolimus và AKI cũng được cân nhắc. Chúng tôi đã bao gồm 110 bệnh nhân. AKI xảy ra ở 57% bệnh nhân trong tuần đầu tiên. Tình trạng hồi phục sau AKI được ghi nhận ở 24%. Tỷ lệ bệnh thận mạn tính (CKD) là 19% sau 1 năm. Nồng độ tacrolimus trong huyết tương thường vượt quá mức điều trị và, mặc dù đã điều chỉnh cho các yếu tố gây nhiễu, vẫn độc lập liên quan đến AKI (OR 1.66; 95% CI 1.20–2.31). Nồng độ tacrolimus trong huyết tương vượt mức điều trị độc lập liên quan đến sự phát triển của AKI ở bệnh nhân ghép tim người lớn. Việc điều chỉnh liều tacrolimus nghiêm ngặt hơn ngay sau khi ghép có thể là rất quan trọng trong việc bảo tồn chức năng thận.
Từ khóa
#tổn thương thận cấp #ghép tim #tacrolimus #nồng độ trong huyết tương #bệnh thận mạn tínhTài liệu tham khảo
Stehlik J, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report–2012. J Heart Lung Transpl. 2012;31:1052–64.
Guethoff S, Meiser BM, Groetzner J, Eifert S, Grinninger C, Ueberfuhr P, et al. Ten-year results of a randomized trial comparing tacrolimus versus cyclosporine a in combination with mycophenolate mofetil after heart transplantation. Transplantation. 2013;95:629–34.
Penninga L, Møller CH, Gustafsson F, Steinbrüchel DA, Gluud C. Tacrolimus versus cyclosporine as primary immunosuppression after heart transplantation: systematic review with meta-analyses and trial sequential analyses of randomised trials. Eur J Clin Pharmacol. 2010;66:1177–87.
Zijlstra LE, Constantinescu AA, Manintveld O, Birim O, Hesselink DA, van Thiel R, et al. Improved long-term survival in Dutch heart transplant patients despite increasing donor age: the Rotterdam experience. Transpl Int. 2015;28:962–71.
Nankivell BJ, P’Ng CH, O’Connell PJ, Chapman JR. Calcineurin inhibitor nephrotoxicity through the lens of longitudinal histology: comparison of cyclosporine and tacrolimus eras. Transplantation. 2016;100:1723–31.
Lund LH, Edwards LB, Kucheryavaya AY, Dipchand AI, Benden C, Christie JD, et al. The Registry of the International Society for Heart and Lung Transplantation: thirtieth official adult heart transplant report-2013; focus theme: age. J Heart Lung Transpl. 2013;32:951–64.
Healy AH, Stehlik J, Edwards LB, McKellar SH, Drakos SG, Selzman CH. Predictors of 30-day post-transplant mortality in patients bridged to transplantation with continuous-flow left ventricular assist devices—an analysis of the International Society for Heart and Lung Transplantation Transplant Registry. J Heart Lung Transpl. 2016;35:34–9.
Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb S, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-second Official Adult Heart Transplantation Report-2015; focus theme: early graft failure. J Heart Lung Transpl. 2015;34:1244–54.
Söderlund C, Löfdahl E, Nilsson J, Reitan Ö, Higgins T, Rådegran G. Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988–2010. Transpl Int. 2016;29:529–39.
De Santo LS, Romano G, Amarelli C, Maiello C, Baldascino F, Bancone C, et al. Implications of acute kidney injury after heart transplantation: what a surgeon should know. Eur J Cardiothorac Surg. 2011;40:1355–61 (Oxford University Press; discussion1361).
MacDonald C, Norris C, Alton GY, Urschel S, Joffe AR, Morgan CJ, et al. Acute kidney injury after heart transplant in young children: risk factors and outcomes. Pediatr Nephrol. 2016;31:671–8 (Springer Berlin Heidelberg).
Tjahjono R, Connellan M, Granger E. Predictors of acute kidney injury in cardiac transplantation. Transpl Proc. 2016;48:167–72.
Gude E, Andreassen AK, Arora S, Gullestad L, Grov I, Hartmann A, et al. Acute renal failure early after heart transplantation: risk factors and clinical consequences. Clin Transpl. 2010;24:E207–13 (Blackwell Publishing Ltd).
Delgado JF, Crespo-Leiro MG, Gómez-Sánchez MA, Paniagua MJ, González-Vílchez F, Vázquez de Prada JA, et al. Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clin Transpl. 2010;24:E194–200.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.
Aidong W, Zhenjie C, Tong L, Lei Z, Yin W, Shanqi Z, et al. Therapeutic drug monitoring of tacrolimus in early stage after heart transplantation. TPS. 2004;36:2388–9.
Salm P, Rutherford DM, Taylor PJ, Black MJ, Pillans PI. Evaluation of microparticle enzyme immunoassay against HPLC-mass spectrometry for the determination of whole-blood tacrolimus in heart- and lung-transplant recipients. Clin Biochem. 2000;33:557–62.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179–84 (Karger Publishers).
Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13:241–57 (Nature Publishing Group).
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12 (NIH Public Access).
Christians U, Jacobsen W, Benet LZ, Lampen A. Mechanisms of clinically relevant drug interactions associated with tacrolimus. Clin Pharmacokinet. 2002;41:813–51 (Springer International Publishing).
Kramer L, Jordan B, Druml W, Bauer P, Metnitz PGH. Incidence and prognosis of early hepatic dysfunction in critically ill patients—a prospective multicenter study. Crit Care Med. 2007;35:1099-e7.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. Crit Care Med. 2012;2013:580–637.
Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–30.
Sikma MA, Hunault CC, van de Graaf EA, Verhaar MC, Kesecioglu J, de Lange DW, et al. High tacrolimus blood concentrations early after lung transplantation and the risk of kidney injury. Eur J Clin Pharmacol. 2017;73:573–80 (Springer Berlin Heidelberg).
Xu J-R, Zhu J-M, Jiang J, Ding X-Q, Fang Y, Shen B, et al. Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltimore). 2015;94:e2025.
Garzotto F, Piccinni P, Cruz D, Gramaticopolo S, Dal Santo M, Aneloni G, et al. RIFLE-based data collection/management system applied to a prospective cohort multicenter italian study on the epidemiology of acute kidney injury in the intensive care unit. Blood Purif. 2011;31:159–71.
Lee JM, Lee S-A, Cho H-J, Yang H-M, Lee H-Y, Hwang HY, et al. Impact of perioperative renal dysfunction in heart transplantation: combined heart and kidney transplantation could help to reduce postoperative mortality. Ann Transpl. 2013;18:533–49.
Hortelano S, Castilla M, Torres AM, Tejedor A, Boscá L. Potentiation by nitric oxide of cyclosporin A and FK506-induced apoptosis in renal proximal tubule cells. J Am Soc Nephrol. 2000;11:2315–23.
Nankivell BJ, Borrows RJ, Fung CLS, Oconnell PJ, Chapman JR, Allen RDM. Delta analysis of posttransplantation tubulointerstitial damage. Transplantation. 2004;78:434–41.
Esteva-Font C, Ars E, Guillen-Gomez E, Campistol JM, Sanz L, Jimenez W, et al. Ciclosporin-induced hypertension is associated with increased sodium transporter of the loop of Henle (NKCC2). Nephrol Dial Transpl. 2007;22:2810–6.
Catarsi P. Angiotensin-converting enzyme (ACE) haplotypes and cyclosporine A (CsA) response: a model of the complex relationship between ACE quantitative trait locus and pathological phenotypes. Hum Mol Genet. 2005;14:2357–67.
Randhawa PS, Shapiro R, Jordan ML, Starzl TE, Demetris AJ. The histopathological changes associated with allograft rejection and drug toxicity in renal transplant recipients maintained on FK506. Am J Surg Pathol. 1993;17:60–8.
Bai JPF, Lesko LJ, Burckart GJ. Understanding the genetic basis for adverse drug effects: the calcineurin inhibitors. Pharmacotherapy. 2010;30:195–209.
Naesens M, Kuypers DRJ, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol. 2009;4:481–508.
Ozdemir BH, Ozdemir FN, Demirhan B, Haberal M. TGF-beta1 expression in renal allograft rejection and cyclosporine A toxicity. Transplantation. 2005;80:1681–5.
Myers BD, Ross J, Newton L, Luetscher J, Perlroth M. Cyclosporine-associated chronic nephropathy. N Engl J Med. 1984;311:699–705.
Nankivell BJ, Borrows RJ, Fung CLS, O’Connell PJ, Allen RDM, Chapman JR. The natural history of chronic allograft nephropathy. N Engl J Med. 2003;349:2326–33.
Sánchez-Lázaro IJ, Almenar Bonet L, Martínez-Dolz L, Buendía Fuentes F, Navarro-Manchón J, Agüero Ramon-Llin J, et al. Repeated daclizumab administration to delay the introduction of calcineurin inhibitors in heart transplant patients with postoperative renal dysfunction. Rev Esp Cardiol. 2011;64:237–9.
González-Vílchez F, de Prada JAV, Exposito V, García-Camarero T, Fernández-Friera L, Llano M, et al. Avoidance of calcineurin inhibitors with use of proliferation signal inhibitors in de novo heart transplantation with renal failure. J Heart Lung Transpl. 2008;27:1135–41.
Kaczmarek I, Zaruba M-M, Beiras-Fernandez A, Reimann R, Nickel T, Grinninger C, et al. Tacrolimus with mycophenolate mofetil or sirolimus compared with calcineurin inhibitor-free immunosuppression (sirolimus/mycophenolate mofetil) after heart transplantation: 5-year results. HEALUN. 2013;32:277–84 (Elsevier).
Arora S, Gude E, Sigurdardottir V, Mortensen SA, Eiskjær H, Riise G, et al. Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients: The significance of baseline glomerular filtration rate. HEALUN. 2012;31:259–65 (Elsevier Inc).
Gullestad L, Mortensen S-A, Eiskjær H, Riise GC, Mared L, Bjørtuft Ø, et al. Two-Year Outcomes in Thoracic Transplant Recipients After Conversion to Everolimus With Reduced Calcineurin Inhibitor Within a Multicenter, Open-Label. Randomized Trial. Transplantation. 2010;90:1581–9.
Kaplinsky E, González-Costello J, Manito N, Roca J, Barbosa MJ, Nebot M, et al. Renal function improvement after conversion to proliferation signal inhibitors during long-term follow-up in heart transplant recipients. Transpl Proc. 2012;44:2564–6.
Thibodeau JT, Mishkin JD, Patel PC, Kaiser PA, Ayers CR, Mammen PPA, et al. Tolerability of sirolimus: a decade of experience at a single cardiac transplant center. Clin Transpl. 2013;27:945–52.
Manito N, Delgado JF, Crespo-Leiro MG, Arizón JM, Segovia J, González-Vílchez F, et al. Twelve-month efficacy and safety of the conversion to everolimus in maintenance heart transplant recipients. World J Transpl. 2015;5:310–9.
Bragadottir G, Redfors B, Ricksten S-E. Assessing glomerular filtration rate (GFR) in critically ill patients with acute kidney injury—true GFR versus urinary creatinine clearance and estimating equations. Crit Care. 2013;17:R108.