FK 506 primary immunosuppression following emergency liver transplantation for fulminant hepatic failure

Abstract The efficacy and safety of an FK 506-compared to a cyclosporin A based immunosuppression regimen was examined in liver recipients who underwent transplantation for fulminant hepatic failure in the European FK 506 liver study. A consistent trend towards improved patient and graft survival noted in the FK 506-treated patients was apparent from the first postoperative week (e. g. patient survival: day 7, 95.5% vs. 82.1% and month 6, 72.7% vs. 60.7%). Acute (in particular intractable) rejection was less frequent in the FK 506 group (e. g. cumulative intractable rejection rate at 6 months, 6.2% vs. 22.6%). In a single centre (Kings College Hospital), 17 patients were studied in more detail. The FK 506 treatment group had improved graft function, lower steroid requirments and episodes of infection. Accompanying these benefits, apache 111 and TISS scores were lower in this group in the early posttransplant period. Intensive care discharge was earlier and both treatment groups experienced similar toxicity.     

Neurotoxicity after orthotopic liver transplantation in cyclosporin A-and FK 506-treated patients

Abstract Neurotoxicity is a serious complication following orthotopic liver transplantation leading to increased morbidity and mortality. Neurotoxicity may be evoked by various perioperative factors, or may be due to drug-pecific toxicity of immunosuppression. In the present study we evaluated the incidence of central nervous system (CNS) toxicity occurring within the early postoperative period of 121 patients, 61 randomly assigned to FK 506- and 60 to CsA-based immunosuppression as part of a multicentre study. The incidence of moderate or severe CNS toxicity was higher in patients treated with FK 506 (21.3%) than in patients receiving CsA (11.7%). The duration of symptoms was also greater in patients treated with FK 506 than in patients receiving CsA. The incidence of moderate or severe neurotoxicity after retransplantation was markedly greater in patients treated with FK 506 (100% of the patients).     

以FK506为基础的四联免疫抑制方案应用于肝移植的研究

目的 探索以FK506为基础的四联免疫抑制方案在肝移植患者中的应用.方法 2001年2月到2004年7月间40例成人尸体肝移植患者接受以FK506为基础的四联免疫抑制方案,比较高浓度（QH）组与低浓度（QL）组在术后6个月时的有效性与安全性.结果 两组在急性排斥反应率、人/肝存活率、高血压、高血糖、感染的发生率差异均无统计学意义;QL组的手震颤发生率显著低于QH组（χ^2=5.105,P=0.624）,术后15 d、3个月血肌酐水平在QL组显著低于QH组（t15天=2.10,P15天=0.042;t3月=2.45,P3月=0.019）,术后3个月、6个月血胆固醇水平在QL组显著低于QH组（t3月=2.35,P3月=0.024;t6月=2.11,P6月=0.042）.结论 QL组使用四联免疫抑制的安全性较好.用四联方案在术后6个月内FK506的血药浓度可控制在5～8 ng/ml.血胆固醇、血肌酐水平、手震颤的发生率与FK506的血药浓度呈正相关.