陳香吟EXSON DAVID CRUZ2026-09-092026-09-092026-07-09https://handle.ncl.edu.tw/11296/6r55g8https://203.71.86.71/handle/123456789/74476學位別：碩士 語文別：英文 指導教授：陳香吟 口試委員：張雅惠; 姜易醇; 陳香吟 授權範圍：網際網路,開放日期為2026-07-16 電子論文連結：https://handle.ncl.edu.tw/11296/6r55g8Background Dyslipidemia contributes to increased long-term morbidity and cardiovascular-related mortality and is known to be a common metabolic complication following SOT. Sirolimus has been associated with lipid abnormalities, whereas tacrolimus exhibits a distinct metabolic profile. Current evidence comparing the risk of dyslipidemia across these immunosuppressive agents is limited and largely based on single-center studies. Large-scale real-world investigations assessing dyslipidemia risk across diverse transplant populations are missing. Objective This research aimed to compare the risk of dyslipidemia between solid organ transplant patients treated with sirolimus and tacrolimus immunosuppressive therapy, in addition to assess dyslipidemia severity based on established lipid threshold categories, and to evaluate variation in risk across transplant types and selected clinical comorbidities. Methods An observational retrospective study was carried utilizing the TriNetX network. The study included patients 18 years or older who had received sirolimus or tacrolimus between January 1, 2010, and December 31, 2024. Individuals with pre-existing dyslipidemia, baseline lipid abnormalities, prior use of lipid-lowering medications, graft failure, or all-cause mortality were excluded. PSM was performed using demographic attributes, BMI, transplant type, tobacco use, clinical comorbidities, and concomitant immunosuppressive medications. Observation period was 24 months after treatment and the outcome was incident laboratory-defined dyslipidemia. Results After covariate balancing, both treatment groups consisted of 3,294 patients. During 24 months of follow-up, dyslipidemia developed in 22.95% of patients treated with sirolimus compared with 19.92% of those receiving tacrolimus. Patients receiving sirolimus experienced a significantly higher risk of dyslipidemia than those treated with tacrolimus (RR = 1.15, 95% CI 1.05-1.26). The magnitude of dyslipidemia risk became greater as severity increased, with RRs of 1.16 (95% CI 1.03-1.29), 1.26 (95% CI 1.11-1.44), and 1.73 (95% CI 1.20-2.50) for the borderline-high, high, and very high categories, respectively. When stratified by transplant type, the association remained significant in kidney and liver transplant recipients (RR = 1.21, 95% CI 1.07-1.36; and RR= 1.32, 95% CI 1.11-1.58, respectively), whereas no significant association was found among heart transplant recipients (RR = 0.92, 95% CI 0.73-1.15). Similar increases in risk were observed among recipients with hypertension and chronic kidney disease. Conclusion Patients prescribed sirolimus as immunosuppressant post solid organ transplantation have a higher risk of developing dyslipidemia compared to tacrolimus. The risk rises with increasing severity of dyslipidemia and differs depending on transplant type and comorbidities. These results highlight the need for regular lipid monitoring, personalized cardiovascular risk evaluation, and proactive management of metabolic issues in patients on sirolimus-based immunosuppressive therapy.系所名稱：藥學系碩士班thesis