在移植肾功能稳定的受者中主动撤除环孢素A的临床研究

目的 研究在移植肾功能稳定的受者中主动撤除环孢素A(CSA)对急性排斥反应发生率及肾功能的影响.方法 选择35例肾功能稳定的肾移植受者,其中尸体肾移植23例,亲属活体肾移植12例.除2例为再次肾移植外,其余均为初次肾移植.分别在肾移植术后6个月～6年时停用CsA,平均为术后(13.3±9.1)个月.撤除CsA后免疫抑制方案为:霉酚酸酯(MMF)+西罗莫司(SRL)+泼尼松(Pred).撤除CsA前有9例做了移植肾穿刺活检,8例测定了抗HLA抗体.结果 对35例受者随访6个月～4.5年,平均14.8个月.撤除CsA前、后血肌酐平均值分别为(88.1±15.5)μmol/L和(92.3±23.7)/μmol/L(P0.05).撤除CsA后,有2例经活检证实发生急性排斥反应,治疗后均逆转;CsA所致的毒副作用,如牙龈增生、糖耐量异常和多毛症等明显改善.9例移植肾活检中,有3例肾功能正常的受者已出现轻度慢性移植肾肾病表现.抗HLA抗体检测中,7例阴性者在撤除CsA前、后肾功能无明显变化.1例抗HLA抗体呈强阳性者在撤除CsA后进展为慢性移植肾肾病,恢复血液透析.结论 对移植肾功能稳定的受者在移植6个月后撤除CsA,转换为"霉酚酸酯+西罗莫司+泼尼松"的免疫抑制方案是安全的,不增加急性排斥反应风险;撤除CsA有利于消除一些与其相关的毒副作用;对抗HLA抗体呈强阳性者.撤除CsA后很难改变肾功能的进展.

Clinical research on active withdrawal of cyclosporine A in kidney transplantation recipients with stable renal function

Objective To investigate the effect of the active withdrawal of cyclosporine A (CsA) on the incidence of acute rejection and long-term graft function in stable renal transplant recipients. Methods CsA withdrawal was offered to 35 recipients with stable renal function 6 months to 6 years posttransplantation [average, (13.3±9.1) months], including 23 eadaveric and 12 living- related kidney transplantations (33 were recipients of a primary and 2 of a second renal transplant). The recipients had taken mycophenolate mofetil (MMF) + sirolimus (SRL) + prednisone (Pred) irnmunosuppressive regimen after CsA withdrawal. Nine patients received transplanted kidney needle biopsy, and 8 patients had been examined for the HLA antibody assay before CsA withdrawal. Results Thirty-five recipients had been followed up for 6 months to 4. 5 years, with a mean time of 14. 8 months. The serum creatinine level before CsA withdrawal (88.1±15.5) μmol/L was different from that after conversion (92.3±23.7) μmol/L, P>0.05. Two episodes of biopsy confirmed acute allograft rejections were reversed after treatments. Side effects of CsA had been relieved, such as gingival hyperplasia, carbohydrate tolerance abnormity, polytrichosis, and so on. Three recipients with normal renal function had the lower degree of chronic allograft nephropathy in the histologic lesions. Seven recipients with negative HLA antibody maintained stable graft function after CsA withdrawal. One recipient with positive HLA antibody had proceeded to chronic allograft nephropathy and returned to hemodialysis. Conclusion Withdrawal of CsA in stable renal transplant recipients 6 months posttransplantation and conversion to MMF + SRL + Pred immunosuppressive regimen didn't increase the risk of acute rejection and were beneficial for eliminating toxic and side effects of CsA, but it was difficult to reverse the progress of chronic allograft nephropathy for positive HLA antibody recipients.