穿透性角膜移植术治疗坏死性基质角膜炎的临床报告

目的：探讨穿透性角膜移植术(penetrating keratoplasty，PKP)治疗坏死性基质角膜炎(necrotizing strornal keratitis)的手术适应证及其临床效果。方法：按照Holland等的HSK新分类法，选择确诊坏死性基质角膜炎患者。予以局部及全身药物治疗。对病情不能控制，药物治疗无效的患者22例(23只眼)，其中角膜融解穿孔3眼，用新鲜角膜组织行穿透性角膜移植术，并随访观察术后疗效。结果：随访3月～3年，22例(23只眼)中，术后视力提高者18眼，其中矫正视力达到0.1～0.5者12眼，0.05～0.1者6眼。无改善者5眼。角膜植片透明17眼，半透明2眼，植片混浊4眼，植片透明率为74％。术后3眼植片发生排斥反应，3眼原发病灶复发。2眼术后因排斥反应及原发病灶反复发作，植片完全混浊，行2次角膜移植术。结论：对药物保守治疗无效、角膜坏死穿孔或行将穿孔的坏死性基质角膜炎患者，及时用新鲜角膜组织行穿透性角膜移植术治疗，不仅能控制炎症，缩短病程，而且能保存眼球，恢复部分视力，因此具有重要临床应用价值。     

角膜移植术治疗圆锥角膜效果分析

目的观察穿透性角膜移植术治疗圆锥角膜的疗效。方法对11例（12眼）圆锥角膜患者行穿透性角膜移植术,对手术进行分析讨论,观察术后视力,分析影响视力的原因及术后并发症产生的原因。结果术后所有患者视力均有显著提高,全部角膜植片透明。植片大小、术后并发症、拆线时间、术后角膜屈光状态,都会影响术后视力。结论穿透性角膜移植术治疗圆锥角膜可显著提高视力,并发症少,是目前较为安全有效的治疗方法。     

他克莫司滴眼液对高危角膜移植术后免疫排斥反应的影响观察

摘要：目的:观察他克莫司滴眼液在预防高危角膜移植术后免疫排斥反应中的作用。方法:眼科行高危角膜移植术患者98例(100眼)随机分为他克莫司组49例(50眼)、环孢素组49例(50眼)。他克莫司组术后局部应用0.1%他克莫司滴眼液环孢素组局部应用1%环孢素A滴眼液起始给药剂量均为1滴,qid,根据患者恢复情况调整剂量,连续给药12个月。分别于术后1 2,12个月时进行复查,记录免疫排斥反应发生情况,比较两组患者术后12个月的视力、眼压变化及眼部体征,包括角膜水肿、角膜基质混浊、角膜上皮缺损、角膜新生血管程度。结果:术后1个月,两组免疫排斥反应发生率比较差异无统计学意义(P>0.05),术后12个月,他克莫司组免疫排斥反应发生率(4.00%)明显低于环孢素组(26.00%)(P<0.05)。他克莫司组术后12个月的角膜水肿评分、角膜基质混浊评分、新生血管分布评分均优于环孢素组(P<0.05);两组最佳矫正视力比较,差异无统计学意义(P>0.05)。两组术后眼压升高例数与眼压范围比较差异均无统计学意义(P>0.05),未见其他相关并发症出现。他克莫司组的不良反应发生率低于环孢素组(P<0.05)。结论:0.1%他克莫司滴眼液用于高危角膜移植术后免疫排斥反应安全、有效,其短期预防作用与环孢素A滴眼液相当,长期预防作用优于环孢素A滴眼液。     

他克莫司滴眼液与环孢素A滴眼液在全角膜移植术后免疫排斥反应的疗效观察

目的　观察 0 .0 5 %他克莫司 (FK5 0 6 )滴眼液与 1%环孢素A(CsA)滴眼液在全角膜移植术后免疫排斥反应的临床疗效。方法　选择 6 2例 (6 2只眼 )全角膜移植术后的患者 ,按随机原则将其分试验组 (FK5 0 6组 )及对照组 (CsA组 )各 31例 31只眼 ,平均年龄 37.8岁。观察应用两种滴眼液后不同时期角膜移植术后角膜免疫排斥的情况。结果　在全角膜移植术后第 6个月FK5 0 6组排斥率为 6 8.4 % ,CsA组排斥率为 92 .1% ,在统计学有显著差异 (P <0 .0 1)。结论　FK5 0 6滴眼液用于角膜移植术后抗排斥反应疗效明显优于CsA滴眼液。经动物试验及临床应用 ,未见有不良反应。     

角膜移植术后应用环孢霉素A抑制排斥反应的护理

角膜移植术是采用同种异体的透明角膜代替因病变而混浊角膜的手术。最常见的术后并发症为免疫排斥反应。术后应用环孢霉素 A 滴眼,防止排斥反应效果良好.规报告如下。1 一般资料从1990～1996年我科行穿透性角膜移植术42例,男29例,女13例:年龄18～72     

深板层角膜移植术临床疗效观察

为观察角膜内皮功能正常的角膜盲患者行深板层角膜移植术的增视效果及脱盲比例,探讨深板层角膜移植术的临床应用适应证及手术技巧,采用角膜基质层间注入生理盐水或2%甲基纤维素等多种分离方法对内皮功能正常的角膜基质病变患者行深板层角膜移植术28例(28只眼),术后短期应用激素3个月,随访1年。结果表明,28例中24例植片透明,4例角膜半透明。最佳矫正视力0.5以上的20例,0.3以上的5例,0.1以上的3例。28只眼全部脱盲。结论:深板层角膜移植术具有安全、并发症少的优点,由于植片和植床间对合良好,光学效果好,可达到治疗和增视的双重目的。     

穿透性角膜移植术屈光控制的研究进展

角膜是眼球最主要的屈光介质，它的屈光力占眼球总屈光力的3／4左右。角膜屈光力的改变将极大的影响整个眼的屈光状态。穿透性角膜移植术(Penetrating keratoplasty，PKP)是重要的复明手术，但术后存在的屈光不正，引起不同程度的视疲劳综合征，一直是眼科界难以解决的问题。分析屈光不正的成因，对术后屈光状态进行有效控制是值得深入研究的重要领域。本文旨在对影响PKP术后屈光状态的因素及其主要防治方法作一系统回顾。     

他克莫司滴眼液与环孢素A滴眼液在全角膜移植术后免疫排斥反应的疗效观察

目的观察0.05%他克莫司(FK506)滴眼液与1%环孢素A(CsA)滴眼液在全角膜移植术后免疫排斥反应的临床疗效.方法选择62例(62只眼)全角膜移植术后的患者,按随机原则将其分试验组(FK506组)及对照组(CsA组)各31例31只眼,平均年龄37.8岁.观察应用两种滴眼液后不同时期角膜移植术后角膜免疫排斥的情况.结果在全角膜移植术后第6个月FK506组排斥率为68.4%,CsA组排斥率为92.1%,在统计学有显著差异(P<0.01).结论 FK506滴眼液用于角膜移植术后抗排斥反应疗效明显优于CsA滴眼液.经动物试验及临床应用,未见有不良反应.     

带巩膜瓣的指环状角膜移植治疗膨隆期边缘性角膜变性的临床观察

目的观察带巩膜瓣的指环状板层角膜移植术治疗膨隆期边缘性角膜变性(Terrien边缘变性)的临床效果。方法选取郑州市中心医院2005年3月—2009年3月收治的膨隆期Terrien住院患者5例(8眼),采取带巩膜瓣的指环状板层角膜移植术,术后随访12～24个月,观察移植片情况、视力恢复和并发症。结果 7眼术后植片光滑平整,变薄区角膜恢复正常厚度(87.5%);7眼视力提高(87.5%),1眼视力无变化(12.5%);角膜水肿2眼,角膜穿孔1眼,移植片排斥反应混浊1眼。结论带巩膜瓣的指环状板层角膜移植是治疗膨隆期环状Terrien边缘变性的较理想的手术方式,能够取得较好的临床效果。     

环孢素A滴眼液在角膜移植免疫排斥中应用观察

目的探讨环孢素A（CsA）滴眼液应用于角膜移植手术后防治角膜移植排斥反应的疗效。方法对在我院施行穿透性角膜移植术的33例（33眼）病例,术后7d33眼均应用1％CsA滴眼液和妥布霉素地塞米松滴眼液至6个月。结果角膜移植术后出现角膜排斥反应有6例（6眼）,经治疗有5例（5眼）植片排斥反应得到控制,植片恢复透明,有效率83．3％。结论证明在角膜移植求后应用1％CsA滴眼液防治角膜移植排斥反应确实有效。     

受体血清保存植片角膜移植术后排斥反应的实验研究

目的和方法：通过建立兔穿透性角膜移植（PKP）模型，对在受体血清和Hanks液分别进行了24h和72h保存后的兔角膜植片PKP术后的排斥反应指数（RI）进行比较，对受体血清保存的植片能否减轻排斥反应作出 初步的评价。结果：72h保存组的RI明显低于其余3组，而血清和Hanks液两之间保存时间相同的情况下，差异无显著性。结论：支持植片保存液24h公上保存比24h以内者排斥反应发生率低的假说；不支持受体血清保存植片能较其它保存方法减少PKP术后排斥反应率的论断。     

平衡盐溶液保存角膜用于穿透性角膜移植的研究

目的 探讨平衡盐溶液（ＢＳＳ）保存的游离角膜片用于穿透性角膜移植的临床效果。方法 在实验研究的基础上,应用４℃ＢＳＳ保存４￣７２ｈ的游离角膜片对１５６只眼进行穿透性角膜移植（ＢＳＳ保存组）,并与２０只全眼球４℃湿房保存２４￣４８ｈ取下的角膜用于同样手术（湿房保存组）的效果相比较。术后随访观察１￣１０年。结果 ＢＢＳ保存组和湿房保存组的植片透明率分别为７７．６％和７５．０％;排斥反应发生率分别为１７     

穿透角膜移植术治疗急性期圆锥角膜的视光学研究

目的 评价穿透角膜移植术（ＰＫＰ）治疗急性期圆锥角膜（ＡＫＣ）的视光学效果，探讨其屈光控制方法。方法 ＡＫＣ共２７例２７眼，术时行双极电凝处理、与稳定期圆锥角膜（ＳＫＣ）２４例２９眼在同等条件下行ＰＫＰ术。术后７ｄ，１、３、６、１２、１５ｍ分别以角膜地形图等方法测得角膜屈光状态与增视效果。结果ＡＫＣ术后１５月ＵＣＶＡ ０．６９±０．１７，ＢＣＶＡ ０．９６±０．１７，ＳｉｍＫ（４３．３９±０．５２）Ｄ，ＳＡＩ ０．７６±０．２５，ＣＡ （２．２２±０．７２）Ｄ，ＳＥ（－１．７３±０．１４）Ｄ，各时间点的检测参数与ＳＫＣ无统计学差异（Ｐ＞０．０５）。结论 ＡＫＣ与ＳＫＣ行ＰＫＰ术，同样可以获得迅速稳定的视光学效果。     

Induction immunosuppression in kidney transplant recipients older than 60 years of age : safety and efficacy of ATGAM, OKT3 and Simulect

BACKGROUND: The choice of induction immunosuppression for kidney transplantation in elderly recipients is dictated by the consideration of the risk of infection as well as efficacy in the prevention of acute rejection, thus allowing a reduction in subsequent maintenance immunosuppression and its attendant long-term adverse effects. OBJECTIVE: To compare the efficacy and safety of the antibody induction immunosuppression strategies in elderly recipients of kidney transplants. PATIENTS AND METHODS: We present retrospective data analysis on 183 kidney transplant recipients > or = 60 years of age at Hahnemann University Hospital (Philadelphia, PA, USA) over a 12-year period. We compared four consecutive cohorts of kidney transplant recipients receiving lymphocyte immune globulin, equine antithymocyte globulin (ATGAM) [n = 29]; muromonab CD3 (OKT3) [n = 45]; basiliximab (Simulect) with corticosteroid maintenance [n = 40]; and Simulect without corticosteroid maintenance (n = 69). RESULTS: Delayed graft function (DGF) was observed in 48% of patients receiving ATGAM, 35.6% in the OKT3 group and 35% in the Simulect group with corticosteroid maintenance and 36.2% in the Simulect group without corticosteroid maintenance. The rejection rate within the first 3 months was 31% in the ATGAM and OKT3 groups, 17.5% in the Simulect group with corticosteroid maintenance and 14.5% in the Simulect group without corticosteroid maintenance. These differences for DGF and acute rejection were statistically significant between patients receiving ATGAM and OKT3, ATGAM or OKT3 and both groups of Simulect (all p < 0.05). Patients receiving Simulect were free of adverse effects typically encountered by patients receiving polyclonal and monoclonal antibodies for induction. Patients receiving Simulect had much shorter hospital stays and benefited from significant reduction of costs compared with other groups. CONCLUSION: Our data indicate that kidney transplant recipients > or = 60 years of age benefit from induction therapy with Simulect followed by corticosteroid-free maintenance immunosuppression.     

Cyclosporine-sparing effects of daclizumab in renal allograft recipients.

PURPOSE: The safety and efficacy of reduced-dose cyclosporine in renal transplantation were studied. METHODS: Patients receiving their first renal transplant received daclizumab 1 mg/kg every 14 days for a total of five doses, mycophenolate mofetil 1 g twice daily, corticosteroids per the institution's routine protocol, and half of the institution's usual cyclosporine dosage. Trough cyclosporine concentrations targeted were half the customary goals, or 150-200 ng/mL for the first six months and 125-175 ng/mL for months 7-12. A retrospective control group included 15 matched patients who had received full-dose cyclosporine, mycophenolate mofetil, and corticosteroids without daclizumab induction therapy. RESULTS: Thirty patients were studied (15 in each group). At baseline, the control group had a significantly lower panel reactive antibody level (0.13%) than the treatment group (5.2%) (p = 0.01). Mean cyclosporine concentrations at 1, 6, and 12 months were significantly lower in the treatment group (p < 0.0001). No patient in either group had an acute rejection episode. All control patients had cyclosporine-associated adverse effects, compared with seven treatment-group patients (p = 0.0022). The treatment group had 19 infections, versus 29 in the control group (p = 0.39). Three study-group patients and eight control patients required a fine-needle aspiration or biopsy (p = 0.13). CONCLUSION: Among kidney transplant patients at low risk of acute rejection, those treated with daclizumab and low-dose cyclosporine had an identical rate of acute rejection (none) and fewer cyclosporine-associated adverse effects compared with patients in a retrospective control group who received full-dose cyclosporine without daclizumab.     

外周血淋巴细胞穿孔素和颗粒酶B在诊断移植肾急性排斥中的作用

目的探讨外周血淋巴细胞（peripheral blood lymphocyte，PBL）穿孔素和颗粒酶B表达水平在肾移植诊断急性排斥反应（acute rejection，AR）和抗排斥疗效中的关系。方法采用定量逆转录PCR（RT-PCR）方法动态测定AR（n=7）、肾功能延迟恢复（n=8）、近期肾功能正常（n=27）、长期肾功能稳定（n=25）组共67例肾移植患者移植前后PBL穿孔素和颗粒酶B表达水平和AR的关系。结果肾移植术后患者PBL穿孔素和颗粒酶B表达强度依次为AR组、肾功能延迟恢复组、近期肾功能正常组、长期肾功能稳定组，AR组与其它3组有显著性差异（P〈0．01）；其升高时间比临床上出现AR的症状早3d左右，随着AR的逆转，其表达也逐渐降至原有基础水平。结论定量RT-PCR测定PBL穿孔素和颗粒酶B的表达可以是一种无创的、较敏感的早期诊断肾移植AR的发生。并可预测抗排斥反应治疗效果。     

Basiliximab: a review of its use as induction therapy in renal transplantation

Basiliximab (Simulect), a chimeric (human/murine) monoclonal antibody, is indicated for the prevention of acute organ rejection in adult and paediatric renal transplant recipients in combination with other immunosuppressive agents.Basiliximab significantly reduced acute rejection compared with placebo in renal transplant recipients receiving dual- (cyclosporin microemulsion and corticosteroids) or triple-immunotherapy (azathioprine- or mycophenolate mofetil-based); graft and patient survival rates at 12 months were similar. Significantly more basiliximab than placebo recipients were free from the combined endpoint of death, graft loss or acute rejection 3 years, but not 5 years, after transplantation.The incidence of adverse events was similar in basiliximab and placebo recipients, with no increase in the incidence of infection, including cytomegalovirus (CMV) infection. Malignancies or post-transplant lymphoproliferative disorders after treatment with basiliximab were rare, with a similar incidence to that seen with placebo at 12 months or 5 years post-transplantation. Rare cases of hypersensitivity reactions to basiliximab have been reported.The efficacy of basiliximab was similar to that of equine antithymocyte globulin (ATG) and daclizumab, and similar to or greater than that of muromonab CD3. Basiliximab was as effective as rabbit antithymocyte globulin (RATG) in patients at relatively low risk of acute rejection, but less effective in high-risk patients. Numerically or significantly fewer patients receiving basiliximab experienced adverse events considered to be related to the study drug than ATG or RATG recipients. The incidence of infection, including CMV infection, was similar with basiliximab and ATG or RATG.Basiliximab plus baseline immunosuppression resulted in no significant differences in acute rejection rates compared with baseline immunosuppression with or without ATG or antilymphocyte globulin in retrospective analyses conducted for small numbers of paediatric patients. Limited data from paediatric renal transplant recipients suggest a similar tolerability profile to that in adults. Basiliximab appears to allow the withdrawal of corticosteroids or the use of corticosteroid-free or calcineurin inhibitor-sparing regimens in renal transplant recipients.Basiliximab did not increase the overall costs of therapy in pharmacoeconomic studies.CONCLUSION: Basiliximab reduces acute rejection without increasing the incidence of adverse events, including infection and malignancy, in renal transplant recipients when combined with standard dual- or triple-immunotherapy. The overall incidence of death, graft loss or acute rejection was significantly reduced at 3 years; there was no significant difference for this endpoint 5 years after transplantation. Malignancy was not increased at 5 years. The overall efficacy, tolerability, ease of administration and cost effectiveness of basiliximab make it an attractive option for the prophylaxis of acute renal transplant rejection.     

Area-under-the-curve monitoring of prednisolone for dose optimization in a stable renal transplant population

BACKGROUND: Renal transplant recipients were noted to appear cushingoid while on low doses of steroid as part of a triple therapy immunosuppression of cyclosporin A (CsA), prednisolone, and azathioprine. METHODS: The study group comprised adult renal transplant recipients with stable graft function who had received their renal allograft a minimum of 1 year previously (43 studies undertaken in 22 men and 20 women) with median daily prednisone dose of 7 mg (range 3-10). The control group was healthy nontransplant subjects [median dose 10 mg (10-30)]. Prednisolone bioavailability was measured using a limited 6-hour area under the curve (AUC), with prednisolone measured using specific HPLC assay. RESULTS: The median prednisolone AUC/mg dose for all transplant recipients was significantly greater than the control group by approximately 50% (316 nmol x h/L/mg prednisolone versus 218). AUC was significantly higher in female recipients (median 415 versus 297 for men) and in recipients receiving cyclosporin (348 versus 285). The highest AUC was in women on estrogen supplements who were receiving cyclosporin (median 595). A significantly higher proportion of patients on triple therapy had steroid side effects compared with those on steroid and azathioprine (17/27 versus 4/15), more women than men had side effects (14/16 versus 7/22), and the AUC/mg prednisone was greater in those with side effects than without (median 377 versus 288 nmol x h/L/mg). DISCUSSION: The results are consistent with the hypothesis that CsA increases the bioavailability of prednisolone, most likely through inhibition of P-glycoprotein. The increased exposure to steroid increased the side-effect profile of steroids in the majority of patients. Because the major contributor to AUC is the maximum postdose concentration, it may be possible to use single-point monitoring (2 hours postdose) for routine clinical studies.     

Ciclosporin metabolite pattern in blood and urine of liver graft recipients

Summary The pattern of metabolites of ciclosporin in blood and 24 h-urine of 58 liver graft recipients was routinely monitored by HPLC from transplantation until discharge from hospital. Liver function and ciclosporin metabolite pattern in patients with an uncomplicated clinical course and in those with cholestasis or acute rejection were compared.During cholestasis M19 and M1A, and during acute rejection M19, in blood were significantly elevated compared to the control group. Blood M19 was significantly correlated with bilirubin concentration and -glutamyl transferase activity in serum, and M1A with the serum bilirubin concentration. Analysis of the metabolite pattern over the observation period showed higher concentrations of M19 and M1A in blood from patients with cholestasis and acute rejection than in the control group; concentrations were lower in the rejection group than in the cholestasis group. The metabolite pattern in 24 h-urine showed similar alterations in ciclosporin metabolite pattern to those in blood.Cholestasis and rejection shift the ciclosporin metabolite pattern in blood and urine to higher concentrations of M19 and M1A, whereas the concentrations of other metabolites and ciclosporin were not significantly affected.     

Patterns of graft and patient survival following renal transplantation and evaluation of serum creatinine as a predictor of survival: a review of data collected from one clinical centre over 34 years

BACKGROUND: The pattern of renal transplantation has never been described since the introduction of the technique. The purpose of this study was therefore to characterise the pattern of renal transplantation from 1967 to 2000, focusing on renal graft function as a predictor of survival. METHODS: This study was a retrospective analysis of an electronic database. The setting was a single renal transplant centre in the United Kingdom covering a population of 2.2 million and included patients who received at least one renal transplant over the study period (n = 1516). The main outcome measures were patient and graft survival, acute rejection episodes and patterns of graft function, as measure by creatinine levels. RESULTS: There were 559 (36.8%) female patients; 109 (7.2%) patients had pre-existing diabetes. Patient survival was adversely affected by increased age at transplant (p < 0.001): 5-year patient survival from first transplant was 82% for patients aged 0 to 17 years, 80% for 18 to 49 years and 61% for > 49 years. Pre-existing diabetes also adversely affected survival (p < 0.01): 5-year graft survival was 63% for patients with diabetes versus 74% for those without. Graft survival was significantly associated with serum creatinine levels recorded 1 year post-primary transplant (p < 0.001) and with three or more acute rejection episodes (p < 0.05). Neither gender nor diabetes status were statistically significant in predicting graft survival. The number of acute rejection episodes was significantly greater in patients with pre-existing diabetes than those without (61% versus 42%, respectively; p < 0.001). There were no differences in the number of acute rejection episodes occurring across age groups. CONCLUSION: Patient and graft survival improved markedly over the 34-year study period, although patient survival has changed little since 1990. Serum creatinine levels are a reliable predictor of graft survival.