霉酚酸酯用于肝移植术后慢性肾功能损害患者的疗效分析

目的 探讨肝移植术后慢性肾功能损害患者在减少钙调磷酸酶抑制剂(calcineurin inhibitors,CNIs)的基础上联合霉酚酸酯(mycophenolate mofeil,MMF)的临床疗效.方法 对我院28例术前肾功能正常,术后发生慢性肾功能损害的患者在减少CNIs的基础上联合MMF治疗,观察患者肾功能指标的变化,记录相关的不良事件.结果 除1例患者因严重骨髓抑制而停用MMF外,其余27例患者随访30.8个月,期间肾功能均得到一定程度改善.治疗1个月、12个月时患者血清肌酐水平[分别为(124.30±28.27)μmol/L和(119.71±31.36)μmol/L]较治疗前[(134.26±27.25) μmol/L]下降.治疗1个月、6个月、12个月时肌酐清除率、肾小球滤过率较转换治疗前升高,差异均有统计学意义(P＜0.05).治疗期间1例(3.7％)发生急性排斥反应.无巨细胞病毒感染或肿瘤复发发生.5例(18.5％)发生轻度消化道症状(腹胀、腹泻),2例(7.4％)发生缺血性胆管炎.结论 肝移植术后慢性肾功能损害患者转换MMF联合低剂量CNIs免疫抑制方案,可以改善和稳定肾功能,并不增加排斥和感染的发生率.

Clinical outcomes in the use of mycophenolate mofeil in liver transplant patients with chronic renal dysfunction

Objective To evaluate the effect of mycophenolate mofeil (MMF) combined with dose-decreased calcineurin inhibitors (CNIs) in patients who received liver transplanation with chronic kidney malfunction.Methods 28 liver transplant patients with chronic kidney malfunction were prospectively included in this study.MMF was initiated and the dose of the original immunosuppressive drug CNIs decreased.The change in renal function and adverse events were evaluated.Results One patient was discontinued with MMF treatment because of serious myelosuppression.The other 27 patients were treated with MMF with a median of 30.8 months.The basal creatinine values and the basal creatinine clearance were ( 134.26 ± 27.25) μmol/1 and (57.70 ± 16.93) ml/min,respectively.The basal glomerular filtration rate was (53.91±11.63) ml/min.The creatinine values at 1,3,6,12,24 and 36 months were 124.30±28.27 (P=0.006),130.19±29.29 (P=0.174),125.49±38.18 (P=0.194),119.71±31.36 (P=0.010),137.43±42.55 (P＝0.804),and (139.04±39.80) μmol/L (P=0.916).And the creatinine clearance values at 1,3,6,12,24 and 36 months were 62.57±19.29 (P=0.008),61.18± 19.70 (P=0.086),64.27±22.82 (P=0.018),67.48±22.59 (P=0.002),57.18±19.55 (P=0.405),and (54.56±23.48) ml/minute (P=0.708),respectively.The glomerular filtration rate at 1,3,6,12,24 and 36 months were 59.20 ± 14.05 (P=0.006),56.61±14.01 (P=0.04),60.47±17.33 (P=0.016),63.59±17.66 (P=0.002),53.75±13.60 (P=0.369),and (51.70±16.07) ml/min (P＝0.703).One patient (3.7％) had mild acute rejection.5 patients (18.5 ％ ) had mild abdominal distention or diarrhea.2 patients (7.4％) had ischemic cholangitis.No patient had cytomegalo virus infection or tumor recurrence.Conclusion In liver transplant recipients with chronic renal dysfunction,MMF allowed CNIs dose reduction or discontinuation,improved or stabilized renal function in most patients and it had only mild adverse events.