肾移植后不同时期转换为吗替麦考酚酯长期治疗的疗效观察

Clinical outcomes in renal allograft recipients switched to long-term immunosuppressive therapy withmycophenolate mofetil after renal transplantation

目的观察并评价肾移植后不同时期转换为吗替麦考酚酯（MMF）对受者肾功能的影响。方法多中心、非干预性观察研究，463例分为2组：Switch组（340例），肾移植6个月后转换为MMF治疗，转换起随访4年；Stay组（123例），肾移植后一直应用MMF治疗，入组后随访4年。2组内各分为4个亚群：A群，移植后6个月至1年转换（或入组）；B群，移植后1—2年转换（或入组）；C群，移植后2—5年转换（或入组）；D群，移植5年后转换（或入组）。结果Switch组转换后受者的肾小球滤过率（GFR）明显改善，其斜率改变为3．1ml·min^-1·年。（P〈0.01）；Stay组入组前后的GFR则保持稳定（P〉O．05）。Switch组各亚群间肾功能下降发生时间的差异有统计学意义（P〈0.01），B群最晚，D群最早；Stay组各亚群间的差异无统计学意义（P〉0．05）。Stay组肾功能正常者的比例每年均高出Switch组12％或以上。结论 肾移植6个月后至数年转换为MMF治疗，均可显著改善受者的。肾功能，越早转换越有利于肾功能的改善。移植后即持续MMF治疗有利于维持受者肾功能的稳定。

Objective To document the impact of conversion to mycophenolate mofetil （MMF） at different time points after transplantation on the renal function of renal function. Methods A long- term,multicenter, non-interventional and observational study was done. Two cohorts were included： One was Switch cohort （340 cases） including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort （123 cases）, including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment. Results GFR values of patients in Switch cohort was significantly increased after switch, and the change in GFR slope was 3.1 mL. min-1 · year-1 （P〈 0. 01）. GFR values of patients in Stay cohort kept steady before and after enrollment, and the change in GFR slope was 0.44 mL.min-1· year-1 （P〉0. 05）. Statistically significant difference in the onset time of GFR decline （defined as 20% decline from the baseline） was observed among subgroups within Switch cohort （P〈0. 01）, but there was no significant difference among subgroups within Stay cohort （P〉0.05）. Stay cohort was 12% higher than in Switch cohort every year. Conclusion Conversion to MMF 〉6 months or even many years after transplantation can obviously improve the renal function of recipients. The earlier conversion can benefit improvement of the renal function.