(
11 Meier-Kriesche HU, Steffen BJ, Chu AH, Loveland JJ, Gordon RD, Morris JA, et al. Sirolimus with neoral versus mycophenolate mofetil with neoral is associated with decreased renal allograft survival. Am J Transplant 2004;4:2058-66. DOI: http://dx.doi.org/10.1111/j.1600-6143.2004.00624.x
http://dx.doi.org/10.1111/j.1600-6143.20...
)
|
Registro SRTR |
1998 a 2013 4 anos |
21.017 |
1999 |
- |
de novo
|
CsA/SRL: menor uso de indução no grupo |
79,3% CsA/ MMF 74,6% CsA/ SRL (HR = 1,22) |
ns. |
(
22 Meier-Kriesche HU, Schold JD, Srinivas TR, Howard RJ, Fujita S, Kaplan B. Sirolimus in combination with tacrolimus is associated with worse renal allograft survival compared to mycophenolate mofetil combined with tacrolimus. Am J Transplant 2005;5:2273-80. DOI: http://dx.doi.org/10.1111/j.1600-6143.2005.01019.x
http://dx.doi.org/10.1111/j.1600-6143.20...
)
|
Registro SRTR |
2000 a 2004 3 anos |
44.915 |
5393 |
- |
de novo
|
|
85,9% TAC/ MMF 85,3% CsA/ MMF (HR = 1,15) 82,2% CsA/ SRL (HR = 1,38) 80,3% TAC/ SRL (HR = 1,47) |
92,2% TAC/ MMF 91,0% CsA/ MMF (HR = 1,22) 90,0% CsA/ SRL (HR = 1,49) 89,9% TAC/ SRL (HR = 1,41) |
(
33 Srinivas TR, Schold JD, Guerra G, Eagan A, Bucci CM, Meier-Kriesche HU. Mycophenolate mofetil/sirolimus compared to other common immunosuppressive regimens in kidney transplantation. Am J Transplant 2007;7:586-94. DOI: http://dx.doi.org/10.1111/j.1600-6143.2006.01658.x
http://dx.doi.org/10.1111/j.1600-6143.20...
)
|
Registro SRTR |
2000 a 2005 5 anos |
49.412 |
6394 (73%) |
2325 (27%) |
de novo
|
SRL/MMF: maior idade do doador, maior proporção de doador falecido |
73,8% TAC/ MMF 71,8% CSA/ MMF (HR = 1,16) 68,9% TAC/ SRL (HR = 1,38) 67,6% CSA/ SRL (HR = 1,37) 57,7% SRL/ MMF (HR = 2,01) |
TAC/MMF CSA/MMF (HR = 1,17) TAC/SRL (HR = 1,33) CSA/SRL (HR = 1,49) SRL/MMF (HR = 1,75) |
(
44 Cortazar F, Molnar MZ, Isakova T, Czira ME, Kovesdy CP, Roth D, et al. Clinical outcomes in kidney transplant recipients receiving long-term therapy with inhibitors of the mammalian target of rapamycin. Am J Transplant 2012;12:379-87. DOI: http://dx.doi.org/10.1111/j.1600-6143.2011.03826.x
http://dx.doi.org/10.1111/j.1600-6143.20...
)
|
Coorte Hungria |
2007 3 anos |
1241 |
37 (37%) |
64 (63%) |
conversão |
Maior proporção com história de neoplasia e diabetes |
ns. |
ns. Pacientes com história de neoplasia (HR = 2,6- 5,6) |
(
55 Isakova T, Xie H, Messinger S, Cortazar F, Scialla JJ, Guerra G, et al. Inhibitors of mTOR and risks of allograft failure and mortality in kidney transplantation. Am J Transplant 2013;13:100-10. DOI: http://dx.doi.org/10.1111/j.1600-6143.2012.04281.x
http://dx.doi.org/10.1111/j.1600-6143.20...
)
|
Registro UNOS |
1999 a 2010 2-8 anos |
125.623 |
10.510 (76,4%) |
3.237 (23,5%) |
de novo
|
imTOR sem iCN: maior proporção com história de malignidade, diabetes e rim de doador com critério expandido; maior PRA e TIF |
iCN/imTOR (HR = 1,07) imTOR/ MMF (HR = 1,17) |
iCN/imTOR (HR = 1,13) imTOR/ MMF (HR = 1,25) |
(
66 Knoll GA, Kokolo MB, Mallick R, Beck A, Buenaventura CD, Ducharme R, et al. Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data. BMJ 2014;349:g6679. PMID: 25422259 DOI: http://dx.doi.org/10.1136/bmj.g6679
http://dx.doi.org/10.1136/bmj.g6679...
)
|
Revisão sistemática |
1999 a 2013 1 ano a 4 anos |
2.600 |
|
|
de novo 4.717 (80,3%) conversão 1.159 (19,7%) |
Não reportado |
Não analisado |
imTOR (HR = 1,43) |
(
77 Badve SV, Pascoe EM, Burke M, Clayton PA, Campbell SB, Hawley CM, et al. Mammalian Target of Rapamycin Inhibitors and Clinical Outcomes in Adult Kidney Transplant Recipients. Clin J Am Soc Nephrol 2016 Jul 21. [Epub ahead of print] DOI: http://dx.doi.org/10.2215/CJN.00190116
http://dx.doi.org/10.2215/CJN.00190116...
)
|
Registro Austrália e Nova Zelândia |
1996 a 2012 7 anos |
7.801 |
398 (25,5%) |
1.162 (74,5%) |
de novo 481 conversão precoce 504 conversão tardia 567 |
Maior proporção da raça branca e história de neoplasia. Menor proporção de história de doença cardiovascular e diabetes |
ns. |
imTOR (HR = 1,47) |
(
88 Santos AH, Casey MJ, Wen X, Womer KL. Association of Baseline Viral Serology and Sirolimus Regimens with Kidney Transplant Outcomes: A Fourteen Year Registry-Based Cohort Study in the US. Transplantation 2017;101:377-86. DOI: http://dx.doi.org/10.1097/TP.0000000000001520
http://dx.doi.org/10.1097/TP.00000000000...
)
|
Registro SRTR |
2000 a 2013 5 anos |
56.764 |
2.167 (44,9%) |
2.659 (55,1%) |
de novo
|
Receptor afro-americano; doador de critério expandido e receptor com doença coronariana |
TAC/MMF TAC/SRL (HR = 1,38) SRL/MMF (HR = 1,41) |
TAC/MMF TAC/SRL (HR = 1,59) SRL/MMF (HR = 1,44 |