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首页> 外文OA文献 >Umstellung von Tacrolimus auf Cyclosporin A aufgrund Tacrolimus-induzierter Nebenwirkungen bei Patienten nach Nieren- und Lebertransplantation
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Umstellung von Tacrolimus auf Cyclosporin A aufgrund Tacrolimus-induzierter Nebenwirkungen bei Patienten nach Nieren- und Lebertransplantation

机译：在肾脏和肝脏移植后，由于他克莫司引起的副作用，他克莫司转变为环孢菌素A

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Tacrolimus (Tac) is a potent immunosuppressive agent after liver and kidney transplantation and has lowered the rate of acute rejection episodes among transplant recipients. Up to 20% of liver and kidney transplant patients with Tac therapy develop drug-related side effects, such as nephrotoxicity, neurotoxicity, post-transplant diabetes mellitus and gastrointestinal symptoms. These side effects may cause significant morbidity and impair the patients quality of life. These adverse effects are usually associated with long-term TAC treatment and they are frequently not reversible by dose reduction. Conversion to cyclosporine A- microemulsion (CyA-ME) is an alternative for patients with severe symptoms of chronic tacrolimus toxicity. The aim of this study was to analyze the efficacy and safety of elective conversion from Tac to CyA-ME due to chronic toxicity and its impact on quality of life. In this prospective multicenter study, 56 patients after kidney (n=37) or liver transplantation (n=19) were converted from Tac to CyA-ME-based immunosuppression. After conversion, the different symptoms were documented from the first week until 12 month after converting the immunosuppressive therapy to CyA-ME. During the 12-month-observation period no patient had to be reconverted to tacrolimus-based immunosuppression and no patient developed an acute or chronic rejection due to conversion. The incidence of chronic rejection in our investigation (10,8%) was similar to other studies (4-10%). Also we found no significant change with regard to nephrotoxicity, hypertension or hyperlipidemia. The blood glucose levels showed a trend to lower concentrations. The other side effects improved after the conversion: Neurological symptoms like paresthesia or muscle weakness decreased in most of the patients. Regarding the symptom tremor, the drug conversion had no influence on the intensity. The gastrointestinal side effects (e.g. constipation, nausea, stomach pain, and diarrhea) improved after the conversion to CyA-ME. The conversion from TAC to CyA-ME also reduced cosmetic problems like hair loss or alopecia. In conclusion, when Tacrolimus- induced side effects occur with no response to dose reduction, conversion to CyA-ME is effective and safe, with no increased risk of rejection and with excellent long-term outcome.
机译：他克莫司（Tac）是肝肾移植后的一种有效的免疫抑制剂，并降低了移植受者的急性排斥反应发生率。接受Tac治疗的肝肾移植患者中，多达20％会出现药物相关的副作用，例如肾毒性，神经毒性，移植后糖尿病和胃肠道症状。这些副作用可能会导致严重的发病率并损害患者的生活质量。这些不良反应通常与长期TAC治疗有关，并且通常不能通过降低剂量来逆转。对于患有慢性他克莫司毒性严重症状的患者，可以选择使用环孢素A微乳（CyA-ME）。这项研究的目的是分析由于慢性毒性而从Tac选择性转化为CyA-ME的功效和安全性及其对生活质量的影响。在这项前瞻性多中心研究中，将56例肾脏（n = 37）或肝移植（n = 19）后的患者从Tac转变为基于CyA-ME的免疫抑制。转换后，从将免疫抑制疗法转换为CyA-ME后的第一周到12个月，记录了不同的症状。在12个月的观察期内，无需将患者重新转换为他克莫司为基础的免疫抑制，也没有患者因转换而出现急性或慢性排斥反应。在我们的研究中，慢性排斥反应的发生率（10.8％）与其他研究相似（4-10％）。我们也没有发现关于肾毒性，高血压或高脂血症的显着变化。血糖水平显示出降低浓度的趋势。转换后的其他副作用有所改善：大多数患者的神经系统症状如感觉异常或肌肉无力减少。关于症状性震颤，药物转化对强度没有影响。转化为CyA-ME后，胃肠道副作用（例如便秘，恶心，胃痛和腹泻）得到改善。从TAC到CyA-ME的转化还减少了脱毛或脱发等美容问题。总之，当他克莫司引起的副作用对剂量降低无反应时，转化为CyA-ME是有效和安全的，不会增加排斥的风险，并且具有长期良好的疗效。

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    Saamer Kristina;

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