活体部分小肠移植术后真菌感染的防治

目的 对国内首次成功活体小肠移植患者2例术后真菌感染的防治措施及疗效进行回顾性研究。方法 1999年至今，我院对2例短肠综合征患者成功地进行了活体小肠移植术。术后在应用FK506，骁悉和激素和三联免疫抑制进行强力免疫抑制的同时，采用综合措施防治真菌感染。术前较彻底的防真菌感染准备，连续监测真菌，移植术后连续静脉滴注大蒜（每日30-60mg)和po大扶康（每日50mg)，查至真菌后，采用局部用药，提高全身抗真菌药物剂量并适当地减少激素用量和降低FK506的血药浓度等综合治疗方法。结果 移植术后两受体在口腔和肠道分泌中查到真菌，主要发生在应用大剂量激素冲击和提高FK506用量来治疗急性排斥反应之后。通过综合治疗真菌感染得到控制，未出现系统性的真菌感染。两受体现已分别健康存活24mo和5mo，正常进食，生活自理。结论 活体小肠移植患者术后大蒜素与大扶康联合可有效防治移植后系统性真菌感染。

Prevention and treatment of fungal infection in the living-related small bowel transplantation

AIM To make a retrospective analysis of the effective methods for prevention and treatment of fungal infection in the living-related small bowel transplantation (LSBT).METHODS Two LSBTs have been performed successfully on 2 patients with short gut syndrome in our hospital since 1999.Immunosuppressive agents including tacrolimus (FK506),mycophenolate mofetil (MMF) and methylprednisolone were used for immunosuppression after the transplants.The measures for prevention and treatment of fungal infection included pre-transplant intensive preparation,continuous post-transplant fungal monitoring and intravenous allitridi (30 mg to 60 mg per day) followed by oral fluconazole capsules (50 mg per day).RESULTS Both the recipients suffered one episode of acute rejection and contracted candida infection.The local fungal infection,viz.candida,found in oral and nasal cavity,was curtailed by increasing the intravenous allitridi dose to 120 mg per day and the intravenous fluconazole dose to 100 mg per day,and a temporary reduction of tacrolimus blood lever and methylprednisolone dose.No systemic fungal infection onset was discovered.By now,the recipients have survived 24 and five months respectively since the transplant.CONCLUSION The broad spectrum antifungal allitridi is an effective and well-tolerated agent for the prevention of fungal infection,and intravenous allitridi followed oral fluconazole are therefore effective for prevention and treatment of fungal infection in LSBT.