Eficácia, tolerabilidade e segurança do uso do sirolimo após o transplante renal / Efficacy, tolerability and safety of the use of sirolimus after kidney transplantation

AUTOR(ES)

Nagilla Ione de Oliveira

FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

24/11/2010

RESUMO

Objectives: To evaluate the efficacy, safety and tolerability of the administration of sirolimus (SRL) and prednisone in combination with cyclosporine (CSA) or tacrolimus (TAC) after kidney transplantation. Methods: Retrospective study of 332 kidney transplants performed between 1999 and 2006. Primary efficacy endpoint included treatment failure, defined as the cumulative incidence of biopsy-proven acute rejection, graft loss, death or SRL discontinuation. Results: Living donors were the primary source of the 332 kidneys grafts (92%); the recipients were 37 years old, males (65%), whites (46%) and the prevalence of diabetes was 6%. The patients received SRL combined with CSA (70.8%) or TAC (29.2%). The treatment failure was 22.2% and 47.8% after the first and fifth year of transplantation without difference between the groups. At five years, patient, graft, death-censored graft and free from biopsy-proven acute rejection survival rates were 92.8%, 86.1%, 92.7% and 82.2%. SRL discontinuations (27.1%) were because of adverse effects (22.9%) and inefficacy (3.3%). Dyslipidemia (6%), graft dysfunction (5.2%), proteinuria (4.5%), infection complications (1.5%), delayed wound healing (1.2%) and anaemia (0.9%) were the main reasons for SRL discontinuation. Conclusion: The efficacy of immunosuppressive regimens utilizing SRL combined with calcineurin inhibitors has been established and was comparable to results from the literature. Despite the safety and tolerability were adequate, the major cause for discontinuation of SRL was the occurrence of adverse reactions. At five years of kidney transplantation, 52.2% of patients remained on SRL therapy without previous biopsy-proven acute rejection, graft loss or death.

ASSUNTO(S)

sirolimo tolerância medicamentosa eficácia segurança transplante de rim nefrologia

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