FK506与CsA在肾移植术后抗排斥的临床应用

目的 比较他克莫司(FK506)与环孢素A(CsA)预防肾移植术后排斥反应的效果和安全性。方法 肾移植患者53例分成两组,FK506组为28例,CsA组为25例。其中CsA组因肝功能损害3例,难治性急性排斥反应1例而改换成FK506。FK506起始用0.2mg·kg~(-1)·d~(-1),CsA起始用6mg·kg~(-1)·d~(-1),同时分别联合应用MMF0.75g,每日2次口服,以及术后三天大剂量甲基强的松龙(MP)静滴,第三天改强的松口服,所有病例均严密观察并行血、尿等生化分析。结果 FK506组移植肾功能好,平均7.5天脱酐水平降至平均99.5μmol/L,2例出现排斥反应,经MP连续3d冲击后治愈。CsA组19例移植肾功能良好,6例出现急性排斥,其中3例经MP连续3d冲击后治愈,2例应用OKT3后急性排斥逆转,1例术后3d出现急性排斥经MP与OKT3治疗后改换成FK506,另3例肝损害呈进行性转氨酶升高改换成FK506。FK506组有血糖升高6例(18.8%),高血压5例(15.6％),感染7例(21.9％)。CsA组血糖升高2例(9.5％),高血压5例(23.8％),感染4例(19.0%)。结论肾移植术后应用FK506疗效确切,能有效防治难治性排斥的发生、发展,降低急性排斥的发生率,特别是在乙肝抗原阳性、肝功能受损者比CsA优越。

Clinical application of FK506 and CsA for preventing rejection in renal transplant recipients

Objective To compare the effect and safety of taerolimus(FK506) and cyclosporin( CsA) in the prevention of renal transplant rejection. Methods A total of 53 cases cadaveric kidney transplant recipients were randomly divided into two groups: Group A(2S) receiving FK506,MMF and Pred; Croup B receiving CsA,MMF and Pred. A-mong group B, 3 cases were converted from CsA to FK506 because of hepatoxiciry and refractory acute rejection. Results In group A ,the renal function became normal in average of 7.5 days. A acute rejection occurred in 2,being all recovered by appropriate management. In group B, the renal function recovered nicely in 19. The acute rejection occurred in 6.Of them ,4 cases were converted from CsA to FK506 for the reason of refractory acute rejection and hepa-toxicity. In FK506 group, the hyperglycosemia occurred in 6(18. 8% ); hypertension in 5(15.6%); infection in 7(21. 9% ). In CsA group ,thc hyperglycosemia occurred in 2(9.5% ); hypertension in 5(23.8%);infection in 4(19.0% ). Conclusions FK506 is a safe and effective immunosuppressive agent in renal transplant and it can prevent and treat refractory acute rejection and decrease the episodes of acute rejection , It is better than CsA in patients with abnormal liver function and HBsg positive.