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Böbrek Nakli Hastalarında Nakil Sonrası Erken Dönemde Sirolimus-Tacrolimus Kombinasyonu Sirolimus-Siklosporin Kombinasyonundan Üstünmüdür?

Is Sirolimus-Tacrolimus Combination Superior to Sirolimus-Cyclosporine Combination in Patients with Renal Transplantation During Early Post-Transplantation Stage?

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2012
DOI: 
DOI 10.5262/tndt.2012.1001.08

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
OBJECTIVE: Our aim is to compare efficiency and safety of SRL+Tacrolimus (TAC) combination with that of Sirolimus (SRL) + Cyclosporin (CSA) combination during the early post-transplantation stage (first 3 months). MATE RIAL and Methods: Between 2005 and 2009, 156 patients (F/M: 49/107) who underwent a renal transplantation from a living donor and who were given sirolimus-based immunosuppressive therapy were enrolled in our study. The patients were examined in two groups: Group 1: TAC+SRL: 57(36,5%), Group 2: CSA+SRL: 99(63,5%). After Month 3, the therapy was continued with SRL+Mycophenolic acid+Prednisolone. Analyses were performed using the 3 year data of the patients. Res ults: Demographic data of the groups were similar. The incidences of acute rejection (respectively, 15,8%- 21,2% in group 1 and 2; p:0,480), patient survival (100%-98%; p:0,280), graft survival (98,2%- 98%; p:0,698) were not found significantly different. The frequency rate of glomerular filtration rates, proteinuria, serum hemoglobine, albumine and cholesterol levels, post-transplant diabetes mellitus was found to be similar. ConclusI on: Concomitant use of sirolimus and tacrolimus during the early post-transplant stage showed similar efficiency and safety in short- and long-term compared to combination with cyclosporine
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Abstract (Original Language): 
Amaç : Çalışmamızda böbrek nakli hastalarında erken nakil sonrası dönemde (ilk 3 ay) Sirolimus (SRL)+ Siklosporin (CSA) kombinasyonuna karşın SRL+ Tacrolimus (TAC) kombinasyonunun etkinlik ve güvenilirliğinin karşılaştırılması amaçlanmıştır. GEREÇ ve YÖNTEMLER: Çalışmamıza 2005-2009 yılları arasında merkezimizde canlıdan böbrek nakli yapılmış ve sirolimus bazlı bağışıklık baskılayıcı tedavi kullanan 156 hasta (F/M: 49/107) alındı. Hastalar iki grupta incelendi: Grup 1: TAC+SRL: 57 (%36,5), Grup 2: CSA+SRL: 99 (%63,5). İmmunosupresif tedavi protokolü olarak; ilk 5 gün kalsinörin inhibitörleri(KNI)+ Mikofenolik asid (MFA)+ Prednisolone kullanıldı. 6. günde MFA kesilirken SRL başlandı. KNI’leri 2.aydan sonra doz azaltılarak 3.ayda kesildi. 80.günde MFA %25 doz indirimi ile yeniden tedaviye eklendi. 3.aydan sonra tedaviye SRL+ MFA+ Prednisolone olarak devam edildi. Hastaların 3 yıllık verileri ile analizler yapıldı. Bulgular : Grupların demografik özellikleri benzerdi. Akut rejeksiyon sıklığı (grup 1-2 sırayla %15,8- %21,2; p:0,480), hasta sağkalımı (%100-%98; p:0,280), greft sağkalımı (%98,2-98%; p:0,698), gecikmiş greft işlevi (%14-%20,2; p:0,334), yeni başlangıçlı nakil sonrası diyabetes mellitus (NSDM) (%14-%8,1; p:0,238) sıklıkları arasında anlamlı farklılık yoktu. Glomerüler filtrasyon hızları (GFH), kreatinin, proteinüri, hemoglobin, albümin, LDL kolesterol, trigliserid ve toplam kolesterol düzeyleri benzer bulundu. Sonuç: Çalışmamızda sirolimus ile tacrolimusun erken nakil sonrası dönemde birlikte kullanımı kısa ve uzun vadede siklosporin ile kombinasyona göre etkinlik ve güvenilirlik açısından benzer bulunmuştur.
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