肾移植治疗药物-sirolimus

Sirolimus was approved by the FDA in 1999 and officially launched in the United States. It was later approved in 2002 and officially launched in China, bringing new treatment opportunities and options to many domestic kidney transplant patients.

As an inhibitor of the mTOR receptor, sirolimus has a different mechanism of action than CNI. In the Symphony study, it was believed that the use of sirolimus in first-time transplant patients may lead to an increase in acute rejection. Since sirolimus is not as powerful as CNI in anti-rejection, controlling the SRL concentration range in the early postoperative period to 4 to 8 ng/ml will significantly increase the chance of rejection.

Currently, it is advocated to switch CNI drug treatment 3 to 6 months after transplantation. Many scholars believe that early switching treatment can reduce the nephrotoxicity of CNI drugs, help improve transplanted kidney function, and significantly increase the glomerular filtration rate. It may not be appropriate for kidney transplant patients with proteinuria >800 ms/d and glomerular filtration rate <40 ml/L. Switching therapy is also not suitable for patients with high immune risk, such as PRA-positive patients with multiple histories of acute rejection and recurrence of transplant nephritis. Therefore, the SRL switching regimen is more suitable for patients with low immune risk.

In summary, sirolimus switching therapy in patients with stable renal function in the early stage after renal transplantation can significantly improve renal function, and no increase in acute rejection and other adverse events was found after more than 2 years of follow-up. It should be emphasized that sirolimus switching therapy is more suitable for patients with low immune risk and normal urine protein. Of course, this study is a clinical observational study with a small number of cases. Whether sirolimus (sirolimus) switching therapy in the early stage after kidney transplantation can prolong the long-term survival of the graft and the recipient still needs to be confirmed by further expanding the sample.