免疫抑制方案对移植肾早期各种功能状态的治疗影响

目的：分析肾移植术后早期 不同的肾功能状态下，三种免疫抑制用药方案对移植效果的影响。方法：将1196例肾移植患者根据其初始的免疫抑制用药方案分为A、B、C三组。A组：环孢素A（CsA) 硫唑嘌呤(Aza) 泥尼松（Pred);B组：CsA 霉酚酸酯（MMF）＋Pred;C组：他克莫司（FK506）＋MMF（或Aza) Pred。根据移植后早期肾功能状态，将患者分成肾功能即刻恢复正常（IGF）、缓慢恢复正常（SGF）、未恢复正常（AGF）和延迟恢复正常（DGF）四种情况。统计四种肾功能状态下，A、B、C三组患者的1年移植肾存活率、急性排斥发生率及治疗逆转率、药物副作用和相关并发症。结果：在四种不同肾功能状态下，B组或C组患者的移植肾1年存活率高于A组；B组和C组的急性排斥发生率均低于A组，急性排斥反应逆转率高于A组，但差异无显著性；B组或C组的肝功能损害、肾毒性、高血压的发生率明显低于A组。结论：在肾移植后各种肾功能状态下，B组和C组的免疫抑制方案，都可减少急性排斥反应、药物毒副作用及相关并发症的发生率，提高移植肾的存活率。

Effects of immunosuppressant regimes on the graft survival following renal transplantation with varied early graft functions

Objective To analyze the effects of three immunosuppressant regimes on graft survival after renal transplantation with varied early graft functions.Methods 1 196 cases of cadaver renal transplant performed in our center were divided into the following groups in terms of the initial immunosuppressant regimen used:Group A:cyclosporin A (CsA), azathioprine (Aza) and prednisone (Pred);group B:CsA, mycophenolate mofetil (MMF) and Pred, and group C:tacrolimus (TAC), MMF and Pred. According to their early allograft functions, the recipients were divided into four categories:immediate recovery of graft function (IGF), slow recovery of graft function (SGF), abnormal graft function (AGF) and delayed recovery of graft function (DGF). One-year survival rate, incidences of side effect and related complication, acute rejection rate and retrieval rate were analyzed in each group. Results Under any circumstances of IGF, SGF, AGF and DGF, one-year graft survival in group B or group C was always higher than in group A;The incidence of acute rejection was lower in group B or group C while rejection retrieval rate higher, but did not meet statistical significance;The incidence of hepatic toxicities, renal toxicities and hypertension in group B or group C was lower than in group A(P< 0.05). There was no significant difference in one-year graft survival rate and acute or chronic rejection rate between group B and C. Conclusion The protocols composed of MMF and FK506 greatly decreased the rejection rate and incidence of drug side effect and related complication, and increased the graft survival.