15年肾移植的临床经验

１９７８年４月至１９９４年３月共实施尸体肾移植５９１例，６０６次。迄今人存活５１０例（８６．３％），死亡９６例（１６．２％），肾脏存活４３４例（７３．４％），摘除移植肾７６例（１２．８％）。术后应用Ａｚａ，泼尼松（Ｐｒｅｄ），环磷酰胺，环孢素（ＣｓＡ）、ＡＴＧ、ＯＫＴ３免疫抑制剂。发生超急性排斥９例次，急性排斥反应２１２例次，慢性排斥反应５８例次。本组带肾存活最长１３年３个月，术后１、３、５、１０年肾存活分别为４２０例（８５．７％），２２２例（７７．４％），１１８例（６９．８％），１例（１６．７％）。就怎样合理地选用免疫抑制剂，术后并发症发生的原因，长期存活的经验进行讨论。     

尸体肾移植1 082例次报告

对同种异体肾移植１０５１例１０８２例次进行总结。术后发生超急性排斥反应１２例次，加速性排斥反应３例次，急性排斥反应２８９例次，慢性排斥反应９３例次。人／肾总存活率：１年９４．７％／８７．６％、３年８９．８％／７９．７％、５年８８．３％／７９．１％、１０年５０．０％／３８．６％。最长者存活１６年５个月。１０８２例次的临床研究表明：（１）尸体肾移植是治疗晚期肾脏疾病的有效方法。（２）适应证的选择是保证肾移植成功的关键。（３）良好的ＨＬＡ配型有利于减少移植肾的早期失功和提高肾移植的长期存活率。（４）高质量的供肾、快速的取肾和熟练的植肾手术是保证肾移植成功的重要条件之一。（５）应坚持ＡＢＯ血型、淋巴细胞毒性试验及ＰＲＡ配型工作。（６）合理的应用免疫抑制剂，将激素减到最低量及环孢素血浓度的监测甚为重要。（７）ＡＴＧ或ＯＫＴ３是当前治疗移植肾难治性排斥反应最有效的免疫抑制剂之一。（８）感染是肾移植失败的重要原因，要充分做好预防感染的工作。（９）彩色多普勒超声和ＥＣＴ测定是一种方便、快速、敏捷诊断急性排斥反应的手段。（１０）加强对肾移植患者随访，指导康复期治疗，随时调节免疫抑制剂，这对患者能否长期存活有重要意义。     

终末期糖尿病肾病患者的肾移植：（附32例报告）

对３２例终末期糖尿病肾病（ＥＳＤＮ）患者进行同种异体肾移植手术，经严格术前选择、取肾、植肾、术后治疗，３０例人／肾存活（９３７％），２例失败（６３％）。１年人／肾存活２７例（８４４％），２年２２例（６８８％），３年１５例（４６９％），５年５例（１５６％）。就ＥＳＤＮ接受肾移植手术的国内外现状、诊断标准及移植肾长期存活等问题进行讨论。     

不同分型的高位胆管癌手术切除方式的选择

１９９１年１月至１９９５年１２月，本院收治高位胆管癌５２例，手术切除１７例，切除率３２．７％。切除组中２例Ｉ型和１例Ⅱ型肿瘤行单纯局部切除，１４例行联合肝叶切除；其中１例Ⅱ型行尾叶切除，１例Ⅱ型和３例ⅢＡ型行肝中叶切除，８例ⅢＢ型行左半肝切除，１例ⅢＡ型行右半肝切除。镜下治愈性切除率为１５．４％（８／５２）。治愈性切除组平均生存期为２１．１月，姑息性切除组则为７．５个月（Ｐ〈０．０５）。切除组手术     

肛管直肠恶性黑色素瘤临床病理误诊分析

目的 分析肛管直肠恶性黑色素瘤临床及病理误诊的原因，探讨避免误诊的方法。方法 对１５例肛管直肠恶性黑色素瘤进行回顾性分析和免疫组化观察。结果 临床误诊率为８６．７％（１３／１５）。其中误诊为良性病变占６６．７％（１０／１５），误诊为痔或痔伴有肛周脓肿７例、息肉２例及慢性炎症１例；３例误诊为肛管直肠癌。延误诊治时间３个月至１年。活检病理误诊率为５３．３％（８／１５），其中误诊为低分化腺癌６例，平滑肌     

膀胱癌P_（53）过度表达的临床意义

通过免疫组化ＡＢＣ法，对５０例手术切除或活检的膀胱癌标本石蜡切片进行Ｐ_（５３）基因表达的研究。结果表明：膀胱Ｐ_（５３）蛋白过度表达率为４２％（２１／５０），其中ＰＴ_２４０％（１２／３０），ＰＴ_３８２％（９／１１），ＰＴ_ａ，ＰＴ_１为０；Ｇ_２３２％（８／２５），Ｇ_３７２％（１３／１７），Ｇ_１为０。随访２５例患者，１３例Ｐ_（５３）阳性过度表达，其中有７６％（１０／１３）有复发转移，而单纯复发者只占２３％（３／１３）。１３例Ｐ_（５３）阳性表达者平均存活时间２２．６个月／例，１２例Ｐ_（５３）阴性表达者平均存活６３．７个月／例。Ｐ＜０．０１。     

中晚期肾母细胞瘤的综合治疗(附50例报告)

目的　总结肾母细胞瘤综合治疗效果。　方法　自１９７２ 年３ 月～１９９２ 年６ 月对５０ 例肾母细胞瘤患儿采用患侧肾根治性切除术、放疗（ 根据患儿年龄,总量１ ６００ ～４ ０００ｃＧｙ）、化疗（ 长春新碱、更生霉素单独或联合应用） 的综合治疗措施。　结果　５ 、１０ 年生存率为７２％ （３６／５０） 和５３％（１８／３４）;小于５ 岁与大于５ 岁年龄组,１０ 年生存率分别为６０ ％（１５／２５） 、３３ ％（３／９）,差异有显著性（Ｐ＜０ ．０５）;术后１０ 天内与３０ 天后接受放疗者５、１０ 年生存率分别为８３ ％（１０／１２）、５８ ％ （７／１２）和５３％（８／１５）、３３％ （５／１５）,差异有显著性（ Ｐ＜ ０－０５） 。　结论　肾母细胞瘤综合治疗是提高生存率的关键。年龄越小,接受放疗时间越早,疗效越好。     

无支架异种生物瓣膜主动脉瓣替换术后左室功能变化

评价无支架异种生物瓣膜主动脉瓣替换术后２年左室功能的变化。将８０例同期施行主动脉瓣替换病人分为２组，５０例（年龄６９．３±９．３岁）应用ＴｏｒｏｎｔｏＳＰＶＴＭ瓣；３０例（年龄７１．６±７．７岁）作为对照组接受支架人工瓣膜替换。术前、术后１、６、１２及２４个月间记录Ｍ型及Ｄｏｐｐｌｅｒ超声心动图，采用计算机图像数字分析，定量测定左室功能的变化。随访期间，Ｔｏｒｏｎｔｏ组主动脉瓣跨瓣压差为０．８±０．６ｋＰａ（６．０±４．５ｍｍＨｇ），明显低于对照组２．３±０．９ｋＰａ（１７．３±６．８ｍｍＨｇ）；术后１个月，左室心肌质量下降２５％，左室＋Ｖｃｆ及－Ｖｃｆ明显增加（２．０±０．８／１．４±０．３ｓ－１，Ｐ＜０．０１；２．８±１．２／１．８±０．７ｓ－１，Ｐ＜０．０１）。术后６个月，左室功能进一步改善，心室肥厚的消退更趋完全，该变化在其后的随访期间保持稳定。结论：与支架瓣膜相比，无支架异种生物瓣膜具有较大瓣口开放面积及低跨瓣压差，这促进了术后左室功能的恢复及病理性肥厚的逆转     

腹部手术后肠瘘的治疗

为提高手术后肠瘘的治愈率，作者总结了１９８９年１２月至１９９６年１０月间收治的腹部手术后肠瘘２４例，包括十二指肠瘘６例，高位小肠瘘３例，低位小肠瘘７例，结肠瘘８例，１６例行保守治疗，治愈率７５％（１２／１６），８例行手术治疗，治愈率８７．５％（７／８），全组死亡率２０．８％（５／２４），作者认为治疗应遵循以下原则：（１）明确诊断；（２）结合生长抑素的应用加强营养支持治疗；（３）控制感染；（４）针对     

再次肾移植的临床研究

目的 探讨影响再次肾移植效果的因素。方法 对再次肾移植的４３例患者按术后用药方案的不同分２个组进行回顾性分析。结果 术后急性排斥反应（ＡＲ）的发生率为２７．９％急性肾小管坏死（ＡＴＮ）的发生率为２３．３％，移植后人／肾、１、３、５年存活率分别为８２．４％／６４．７％、７８．３％／６０．９％、６６．７％／５５．５％。环孢素Ａ（ＣｓＡ）组和抗淋巴细胞球蛋白组人／肾１年存活率分别为７７．８％／５５．６％     

Semen variables and hormone profiles after kidney transplantation during adolescence

Our aim was to investigate the semen variables and hormone profiles among transplant patients who received kidneys during adolescence. Seven postpubertal transplant patients who underwent successful renal transplantation during adolescence (13-19 years; 3 were preemptive) were enrolled in our clinical follow-up. Serum levels of prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone were checked together with the semen analysis. The ages of the patients ranged from 18 to 25 years (median, 22 years). The median age was 15 years (range, 12-18 years) at initial presentation. The median time between initial diagnosis and transplantation was 12 months (range, 2-60 months). The median follow-up after transplantation was 51 months (range, 23-134 months). Three of the seven patients had unilateral low testicular volume. The renal function tests were within normal limits, as well as serum levels of prolactin, FSH, LH, and testosterone. Sperm counts ranged from 0.2 to 55 million/mL (median, 1.7 million/mL). Only 1 patient (14.2%) had normal sperm parameters. Oligoteratozoospermia (low sperm count and defects in morphology) was observed in 1/7 (14.2%), asthenoteratozoospermia (low levels of motility and defects in morphology) in 1/7 (14.2%), and all parameters were abnormal in 4/7 (57.1%) cases. Our data suggest that in contrast to adult patients, semen variables are severely affected and spermatogenesis does not improve after renal transplantation when the patient was subjected to uremia before or during adolescence, the crucial period for spermatogenesis.     

Advantage of eradication therapy for Helicobacter pylori before kidney transplantation in uremic patients

From January 1999 to February 2007, 61 end-stage renal disease (ESRD) candidates for kidney transplantation underwent an esophagogastroduodenoscopy (EGDS) to detect Helicobacter pylori (HP). We correlated treatment for HP before transplantation and upper digestive tract hemorrhagic complications and possible recurrence of peptic disease posttransplantation. The 32 (52.4%) HP-Positive cases were divided into 2 groups: (1) 17 patients who underwent treatment for the eradication of the infection with 40 mg/d omeprazole for 4 weeks, 500 mg claritromycin twice daily for 7 days, and 2 g/d amoxicillin for 7 days; and (2) 15 untreated patients. No significant differences were found in the hemorrhagic erosive gastritis of patients with regard to the treated HP-Positive and nontreated HP-Positive patients (2 vs 3) and between the HP-negative patients and the nontreated HP-Positive patients (2 vs 3). The presence of gastric or duodenal ulcers was significantly higher in the nontreated patient than in the treated HP-positive patients (5 vs 1; P=.05) and significantly higher in the nontreated HP-Positive patients than in the HP-negative patients (5 vs 0; P=.05). We concluded that HP-positive patients should therefore be treated for the infection to avoid a long-term significant increase of gastric and/or duodenal peptic disease subsequent to renal transplantation in these immunodepressed subjects.     

非骨水泥全髋关节置换术治疗肾移植术后股骨头坏死的短期疗效

目的 探讨非骨水泥全髋关节置换术(total hip replacement,THR)治疗肾移植术后股骨头坏死(osteonecrosis of the femoral head,ONFH)的短期疗效.方法 回顾性总结非骨水泥THR治疗肾移植术后ONFH患者17例(22髋),男11例,女6例;平均年龄38.4岁(25～64岁).ONFH按ARCO标准分期,Ⅱ C期1例(1髋),ⅢB期2例(3髋),ⅢC期4例(5髋),Ⅳ期10例(13髋).除4例患者THR术前1～5个月停用激素外,其他患者围于术期和术后均维持使用免疫抑制剂.肾移植术前接受血液透析时间平均为16个月(0～87个月),肾移植术至接受THR的平均时间为3.4年(1.5～6年).全部采用非骨水泥THR,Versys股骨假体和Trilogy髋臼假体各5髋,Zweymuller股骨假体和EP-FIT髋臼假体各17髋;金属头对聚乙烯臼13髋,陶瓷头对陶瓷臼9髋.结果 17例患者全部获得随访,平均随访2.3年(11个月～5.1年).Harris评分为优15髋(68.2%),良7髋(31.8%);从术前平均(41.3±6.4)分提高到术后平均(92.2±7.1)分.术后并发症有切口浅表感染1例,下肢深静脉血栓1例,异位骨化1例,假体不稳定1例.结论 非骨水泥THR治疗肾移植术后ONFH可获得满意的短期疗效,长期应用激素和免疫抑制剂并不影响假体的早期稳定性,但中远期疗效有待进一步观察.     

23例儿童肾移植临床分析

目的：探讨儿童肾移植的临床特点，提高肾移植效果。方法：对23例3～17岁的儿童肾移植资料进行回顾性分析。结果：术后随访5d至72个月，平均26．1个月，死亡1例，人、肾1年存活率分别为93．3％和86．6％。术后7例发生急性排斥反应，6例治疗后逆转，1例因并发移植肾静脉栓塞，切除移植肾；2例发生慢性排斥反应，1例移植肾功能丧失，恢复血液透析，另一例仍在随访治疗中；其它并发症有肺部感染4例，心力衰竭2例，肾静脉阻塞2例，肝功能损害2例，急性肾小管坏死1例。结论：儿童肾移植具有一定的特殊性，其血管较细、急性排斥反应发生率较高以及药物代谢快等都是应妥善处理的问题。     

Microvascular surgery in experimental and clinical kidney transplantation

An improved microsurgical technique for orthotopic rat kidney transplantation is described in detail. (1) End-to-end anastomosis of renal arteries with 7-8 interrupted 10-0 sutures. (2) End-to-end anastomosis of renal veins with 2 continuous semicircular 10-0 sutures. (3) Non-splinted end-to-end ureteric anastomosis with 4 interrupted full-thickness 11-0 sutures. (4) Simultaneous bilateral nephrectomy. Seventy transplantations were analysed. No failure due to complications of the vascular anastomoses occurred. The ureteric anastomoses were complicated by stenosis in only 5 animals (7%). The operation times for vascular anastomoses were 20 (15-24) minutes and for complete transplantation 50 (45-60) minutes. This technique seems to be less time consuming than other methods. Our method has produced a success rate of 93% with well standardized and reproducible organ quality. Preliminary clinical experiences with extracorporeal microvascular reconstruction in 4 cases of injured small polar kidney allograft arteries support the continued application in appropriate situations to increase the number of suitable donor kidneys.     

Simultaneous revascularization of the renal arteries in conjunction with reconstruction of aneurysms of the abdominal aorta

Simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta was performed in a consecutive series of 30 patients (mean age: 65 +/- 7 years; men 27 [90%]; women 3 [10%]). Right renal artery was operated upon in 20/30 cases (66%) and left renal artery in 15/30 cases (50%) for a mean degree of stenosis of 79 +/- 19%. Suprarenal extension of the aneurysm of the abdominal aorta was observed in 7/30 cases (23%). Emergency operation because of rupture of the aneurysm was necessary in 7/30 cases (23%). The following procedures were performed upon the renal arteries, either isolated or combined, in addition to resection of the aneurysm of the abdominal aorta: reimplantation of the renal artery in 15 cases, thrombendarteriectomy of the renal artery in 11 cases, patchangioplasty in 8 cases, bypass in 4 cases, dilatation in 1 case, autotransplantation in 1 case. The 30-day mortality was 1/23 (4%) for elective procedures versus 3/7 (43%) for emergency procedures (ruptures). Systolic (diastolic) blood pressure dropped from a preoperative mean value of 181 +/- 139 (104 +/- 18) mm Hg to a postoperative mean value of 147 +/- 18 (80 +/- 18) mm Hg: p less than 0.05 (p less than 0.05). Hence, simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta helps not only to salvage renal parenchyma but also to control the risk factor hypertonia in a significant number of patients.     

夫妻活体供肾移植的相关问题分析

目的 探讨夫妻供肾移植的临床效果及安全性.方法63例活体供肾移植供者分夫妻供肾组(n=12)和亲属供肾组(n=51)2组.总结夫妻活体供肾肾移植的临床资料,并与同期基础条件相近、免疫抑制剂方案相同、基因相关亲属供肾组的临床资料进行对比.观察指标选择平均住院时间、急性肾小管坏死发生率、1年内急性排斥反应发生率和移植后7、30 d和1年血肌酐(SCr)水平.结果 夫妻供肾组和亲属供肾组受者年龄分别为(39±3)和(37±3)岁,P=0.05;透析时间分别为(4.7±3.2)和(4.4±2.9)个月,P=0.78;平均住院时间分别为(20.9±8.3)和(23.0±7.8)d,P=0.41.2组1年内急性排斥反应发生率分别为33.3%4/12),3.9%(2/51),P=0.01.急性肾小管坏死发生率分别为16.7%(2/12),3.9%(2/51)(P=0.31).夫妻供肾组术后7、30 d SCr值分别为(206.47±47.22)和(163.75±25.91)μmol/L,亲属供肾组分别为(142.79±89.42)和(119.99±15.03)μmol/L,P=0.02,P=0.00.术后1年夫妻供肾组获随访9例,亲属供肾组40例;SCr分别为(133.40±6.11)和(121.00±34.12)μmol/L,P=0.25.结论 术前对夫妻供、受者进行全面综合评估是夫妻供肾移植成功的保证.夫妻供肾移植的近期急性排斥反应发生率略高于亲属活体供肾移植,但术后1年夫妻供肾移植受者的移植肾功能与亲属活体供移植受者比较并无区别.     

乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者存活的影响

目的探讨乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(hepatitis C virus,HCV)感染对肾移植受者长期存活的影响及预防措施。方法 HBV和(或)HCV感染肾移植受者110例(感染组),其中HBV感染受者56例、HCV感染受者52例,HBV与HCV合并感染2例。非HBV与非HCV感染受者694例(非感染组)。感染组受者术前有病毒复制者予积极治疗,研究早期肝功能正常者可接受肾移植,后期均用聚合酶链反应(PCR)检测,要求连续3～6个月HBV脱氧核糖核酸(DNA)0copy/ml,HCV核糖核酸(RNA)0copy/ml方可接受肾移植。术后定期检测HBV与HCV,定期检测感染组受者HBVDNA滴度、HCVRNA滴度。发现HBV复制,选用拉米夫定、阿德福韦酯治疗,酌情减少免疫抑制剂用量。分别比较两组术后1、3、5年人、肾存活率,比较两组的肝功能衰竭病死率。结果非感染组人、肾存活率分别为:1年94.2%、91.4%,3年为86.4%、85.2%,5年为82.7%、78.9%;感染组人、肾存活率分别为:1年90.2%、88.1%,3年为88.9%、86.2%,5年为81.5%、76.3%;两组数据比较差异均无统计学意义(均为P>0.05)。感染组中14例(12.7%)死于肝功能衰竭,其中10例为HBV感染者,非感染组受者无1例死于肝衰竭。感染组术后肝衰竭病死率明显高于非感染组(12.7%、0,P<0.05)。结论受者术前HBV和(或)HCV感染会明显增加肾移植术后肝衰竭死亡危险。患者术前处于病毒复制期应予积极治疗,在肝炎病毒停止复制6个月后再考虑肾移植。长期随访中应定期复查HBV与HCV感染指标,早确诊、早治疗,并及时调整免疫抑制剂剂量。     

不同免疫抑制剂所致肾移植受者血脂水平变化的比较

目的 探讨不同免疫抑制剂对肾移植患者术后血脂变化的影响. 方法 肾移植术后患者283例,分别选择他克莫司(FK506),环孢素(CsA)和西罗莫司(SRL)免疫抑制剂治疗方案,比较不同免疫抑制剂患者移植前及术后不同时段血清总胆固醇(TC)和三酰甘油(TG)浓度差异. 结果 FK506组93例患者服药前与服药后96周血清TC和TG浓度分别为(4.9±1.1)、(1.45=0.8)mmol/L与(4.9±1.1)、(1.4±1.0)mmol/L,差异无统计学意义(P>0.05).CsA组106例患者分别为(4.8±1.0)、(1.6±0.8)mmol/L与(6.6±1.7)、(3.2±1.0)mmol/L,差异有统计学意义(P<0.01).CsA组和SRL组患者血清TC和TG浓度一般于服药后12～24周时开始升高.51例服用12周CsA后改为FK506,患者改药前及改药后72周血清TC和TG浓度分别为(6.7±1.1)、(2.8±1.0)mmol/L与(4.7±1.7)、(1.5±1.1)mmol/L,差异有统计学意义(P<0.01). 结论 脂质紊乱是肾移植患者非免疫因素引起慢性排斥反应和慢性移植物失功的重要原因,CsA和SRL是引起肾移植患者术后血脂增高的主要因素之一.对于高脂血症肾移植患者免疫抑制剂应用可优先考虑FK506,避免SRL、CsA合用而加剧血脂升高.     

肝移植后因药物不良反应暂停及转换钙调磷酸酶抑制剂的单中心经验

目的 研究肝移植术后暂停及转换钙调磷酸酶抑制剂(CNI)对控制感染和改善受损肾功能的作用.方法 回顾性分析单中心施行的947例原位肝移植的资料,分为2个阶段,第1阶段(2002年1月至2007年12月)有234例肝移植术后发生感染的患者,第2阶段(2008年1月至2010年12月)有101例.2个阶段共有329例受者因CNI肾毒性而造成肾功能损害,其中将CNI转换为SRL者40例(转换组),其余289例采取CNI减量+吗替麦考酚酯(MMF)加量方案(减量组).结果 肝移植术后存活超过1、3和5年者CNI的应用率分别为95.8%、95.3%和97.5%.第2阶段共有17例受者短期停用免疫抑制剂,停药的主要原因是细菌(部分合并真菌)感染(88.2%);2个阶段共有48例患者将CNI转换为SRL,换药主要原因是肾功能损害(83.3%).第2阶段感染患者中短期暂停CNI者15例,占14.9%(15/101),CNI暂停后感染控制的有效率为73.3%(11/15),排斥反应发生率为6.7%(1/15).第2阶段感染患者的累积存活率明显高于第1阶段(P＜0.05).转换组CNI转换前肾小球滤过率为(0.82±0.24)ml/s,CNI转换后6周时为(1.28±0.31)ml/s,6个月时为(1.36±0.32)ml/s,转换后6周和6个月时高于转换前(P＜0.05).CNI调整后6个月时,转换组患者存活率为85.0%,减量组为83.7%(P＞0.05).结论 肝移植术后患者发生感染及肾功能损害时可采取CNI减量甚至短时间停用CNI,或转换使用SRL,此方案是安全、有效的.

Abstract：

Objective To report the results of a single-center, retrospective study on the effect of calcineurin inhibitors (CNI) withdraw for controlling infections and conversion to sirolimus (SRL)for ameliorating renal dysfunction. Methods A total of 947 liver transplant cases from 2002 to 2010were divided into two eras (Jan. 2002 to Dec. 2007 and Jan. 2008 to Dec. 2010). There were 234cases of infections after liver transplantation (LT) in the first era and 101 cases in the second era. And of 329 cases of CNI-related renal dysfunction after LT in two eras, 40 cases (converting group) had converted CNI to SRL, while 289 cases (reducing group) adopted protocol of CNI reducing and mycophenolate mofetil (MMF) raising. Results CNI-based IS took up 95.8 %, 95. 3 %, 97. 5 % of the IS protocols with recipient survival time longer than 1, 3, and 5 years. The primary cause for CNI withdraw was infection (88. 2 %, 15/17) in the second era, and renal dysfunction for conversion to SRL in the two eras (83. 3 %, 40/48). In the second era, 14. 9% (15/101) of the cases of infections after LT experienced CNI withdraw. Of the 15 patients, 11 had effectively controlled the infection (77. 3 %) while rejection rate was 6. 7 % (1/15). The cumulative survival rate of the second era was significantly higher than the first era (P＜0. 05). The glomerular filtration rate (GFR) of converting group at 6th week and 6th month was statistically elevated as compared with that before conversion,respectively (1.28 ± 0. 31, 1.36 ± 0. 32 mL/s vs. 0. 82 ± 0. 24 mL/s, P＜0. 05). Six months after CNI adjustments, survival rate of converting group and reducing group was 85. 0% and 83. 7 %,respectively (P＞0. 05). Conclusion Reducing or even short-term withdraw of CNI may allow the better control of infections after LT, and the conversion from CNI to SRL can ameliorate the CNIrelated nephrotoxicity. These individually tailored IS protocols will benefit the long term survival for LT.