肝移植术后根据肝活检结果转换西罗莫司治疗:附12例报告

目的 探讨肝移植术后西罗莫司转换治疗后的有效性与安全性.方法 对12例肝移植术后完全停用钙调磷酸酶抑制剂(calcineurin Inhibitor,CNI)改用西罗莫司治疗至少1个月以上的病人进行随访,观察转换治疗后排斥反应的发生及CNI相关肾功能损害和肝功能恢复情况.结果 12例肝移植病人术后平均11个月开始西罗莫司转换治疗,治疗时间平均为14个月,平均随访时间为37个月.采用西罗莫司转换治后,12例中有6例肝穿证实未出现排斥反应.发生CNI相关肾损害的7例中有5例肾功能恢复正常,但有1例反而引起蛋白尿.反复肝功能异常的4例没有改善.结论 我们的小样本临床资料表明,对于某些经过选择的肝移植病人,例如合并CNI相关性肾损害者,可以尝试在肝穿活检指导下进行西罗莫司转换治疗.

Sirolimus conversion therapy based on liver biopsy for maintenance of immunosuppression after liver transplantation: a report of 12 cases

Objective To investigate the safety and efficacy of sirolimus-based immunosuppression therapy in liver transplantation. Methods Immunosuppression in 12 patients after liver transplantation was converted from calcineurin Inhibitor (CNI) to sirolimus for at least one month. Safety evaluations consisted of regular measurements of serum creatinine and liver enzymes to assay the restoration of CNI related nephrotoxicity and hepatoxicity. Efficacy analysis was performed by biopsy to evaluate the rejection incidence. Results The patients were followed up for a mean of 37 months after liver transplantation. Immunosuppression therapy was converted after a mean of 11 months. The average sirolimus conversion therapy period was 14 months. Among 12 patients experiencing sirolimus conversion therapy, 6 did not develop rejection on biopsy. Among 7 patients with CNI-related nephrotoxicity, 5 showed the restoration of serum creatinine to normal but1 developed albuminuria. All four patients with mild liver dysfunction did not improve. Conclusion The conversion from CNI to sirolimus is treatable based on liver biopsy in some selected liver transplant recipients,