肾移植受者同时服用西罗莫司与低剂量环孢素A免疫抑制方案的探讨

目的 探讨肾移植受者同时服用西罗莫司与低剂量环孢素A的免疫抑制方案的可行性及价值.方法 研究分为实验组和对照组,每组肾移植受者各25例.实验组受者肾移植术后时间为2个月～10年,免疫抑制方案采用低剂量环孢素A+西罗莫司+低剂量泼尼松.服药期间,环孢素A血药谷值浓度维持在0.042～0.083 μmol/L;西罗莫司血药浓度控制在4～8 μg/L.并根据白细胞计数、肝功能指标、血脂及临床情况作适当调整.对照组均选择首次肾移植的受者,使用环孢素A+霉酚酸酯+泼尼松的常规免疫抑制方案.对两组受者用药后随访2～8个月.结果 两组受者随访期间,均未发生急性排斥反应,移植肾功能良好;均未发生明显的肝功能异常情况.实验组中1例发生严重肺部感染,经确诊为巨细胞病毒感染,另1例不明原因持续发热,退出观察;两组其它主要不良反应大致相似,包括外周血白细胞计数减低、血脂升高以及口腔溃疡等.结论 同时服用西罗莫司与低剂量环孢素A的免疫抑制方案在维持良好肾功能的情况下,未增加严重的不良反应发生率,而且能够有效避免或减少钙调磷酸酶抑制剂的毒副作用,同时显著降低了受者的药物费用,是一种可供选择的免疫抑制维持方案.

Clinical utility of combined administration of rapamycin and low dose of cyciosporin a in kidney transplantation recipients

Objective To investigate the feasibility and value of combined administration of rapamycin and low dose of cyclosporin A in kidney transplantation recipients. Methods Twenty-five recipients who received their kidney transplantations for 2 months to 10 years were transferred to a new immunosuppression regimen of combined administration of rapamycin,low dose of cyclosporin A and prednisone. During the clinical observation,the average serum trough level of cyclosporin A was maintained between 0.042 and 0.083 μmol/L,and the average serum trough level of rapamycin was controled to 4～8 μg/L. Meanwhile, the dosage of immunosuppressive drugs was adjusted properly according to the white blood cells counting,liver function,blood lipid level and clinical settings.Twenty-five kidney transplant recipients with usual immunosuppression regimen of cyclosporin A in combination with MMF and prednisone served as controls. Results Druing a follow-up period of 2 to 8 months,no acute rejection events were found in this group. All the recipients survived well with functional renal grafts. Two patients in the experimental group quitted during the follow-up. One was incurred to serious pulmonary infection diagnosed as cytomegalovirus infection,and another was sufferred from persistent unknown fever. Other main adverse effects included leucopenia, hyperlipemia and dental ulcer,similarly as control group. No significant abnormal liver function event was found in this group. Conclusions This new immunosuppression regimen of combined administration of rapamycin,low dose cyclosporin A and prednisone in kidney transplantation recipients could avoid or diminish the adverse and toxic effects of calcineurin inhibitors,mainlain well-functional allografts and not increase the incidence of severe untoward reactions. Meanwhile,the costs for taking medicine were also significantly reduced with this regimen. Therefore,it would be an ideal and optimal immunosuppressive maintainence regimen.