Artikel
An open prospective pilot study for the use of Rapamycin after high-risk keratoplasty
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Autoren
Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
Until now cyclosporine A (CSA) and mycophenolate-mofetil (MMF) are the only available systemic immunosuppressants for patients undergoing high-risk keratoplasty. Rapamycin has shown its immunosuppressive potential in the rat keratoplasty model. After kidney transplantation Rapamycin is part of several immunosuppressive protocols. Aim of this study was to prove the efficacy and safety of Rapamycin after penetrating high-risk keratoplasty.
Methods
Ten patients undergoing high-risk keratoplasty were included in this study. Postoperative medication was Fluocortolon 1 mg/kg/d (tapered off within 3 weeks) and Prednisolonacetate eye-drops 5x/d (tapered off within 5 months). Rapamycin was administered orally once daily (blood-trough-level 4-10 ng/ml) for 6 months. Thereafter, it was tapered off within 2 weeks.
Results
Mean follow-up is 378 days. Until now two immune reactions occurred, both of them after cessation of immunosuppression. 8 patients had partly reversible side-effects as hypercholesteremia, furunculosis, exanthem, diarrhea, epistaxis, anemia or elevation of LDH. One patient was excluded from the study due to a pneumonia after pulmonary embolism.
Conclusions
Rapamycin seems to have a similar efficacy as CSA and MMF in preventing immune reactions after high-risk keratoplasty. A broad spectrum of side-effects, however, was observed.