肾移植受者将环孢素A转换为他克莫司治疗的三年疗效分析

目的 评价肾移植受者将环孢素A(CsA)转换为他克莫司(Tac)治疗的有效性和安全性。方法 回顾将CsA转换为Tac治疗的97例肾移植受者的资料，转换治疗的原因分别为慢性移植肾肾病62例，难治性排斥反应21例，肝功能异常8例，齿龈增生、多毛6例。观察转换治疗后3年内的肾功能、肝功能、血脂、血压、血糖、急性排斥发生率、人/肾存活率以及药物不良反应等指标。结果 与转换前相比较，慢性移植肾肾病及难治性排斥反应患者转换治疗1年后肾功能明显好转(P＜0.01)，患者第2、3年肾功能稳定。转换治疗后，肝功能异常者的肝功能明显改善，齿龈增生和多毛患者的症状也明显改善。97例转换治疗后第1年的人/肾存活率分别为100％和97.9％，第3年为100％和92.8％，患者血浆胆固醇、低密度脂蛋白、甘油三酯和血压均下降(P＜0.05)。转换治疗后，13例需用药物控制血糖(13.4％)，另发生腹泻和食欲不振2例(2.1％)，震颤5例(5.2％)。观察期内患者均未发生严重肺部感染和肿瘤。结论 使用CsA行免疫抑制治疗的肾移植受者发生相关并发症后转换为Tac治疗是安全和有效的。

The mid-long term effect of conversion from cyclusporine to tacrolimus in patients with kidney transplantation

Objective To verify the efficacy and safety of conversion from cyclosporine (CsA) to tacrolimus (Tac) in renal transplant recipients. Methods The clinical data of conversion from CsA to Tac in renal transplant recipients were retrospectively analyzed. In 97 patients undergoing kidney transplantation, there were 62 cases of chronic allograft nephropathy (CAN), 21 cases of refractory renal allograft rejection, 8 cases of hepatic impairment, and 6 cases of gingival overgrowth and hirsutism. The patients were followed up with renal function, hepatic function, blood fat, pressure,glucose,acute rejection incidence, patients/kidney survival rate,and adverse drug reaction for 3 years.Results The renal function of patients with CAN and refractory acute rejection was greatly improved after conversion from CsA to Tac treatment at the first year (P＜0. 05) ,and steady at the 2nd or 3rd year. The conversion treatment could greatly improve the hepatic function of patients with dysfunction of liver, improve the gum hypertrophy and hypertrichosis results from CsA. The 1- and 3-year patients/kidney survival rate after conversion from CsA to Tac was 100 ％/97. 9 ％ and 100 ％/92. 8 ％, respectively. The conversion treatment showed a significantly lower degree of plasma cholesterol, low density lipoprotein, triglyceride, and blood pressure (P ＜ 0.05). Incidence of pathoglycemia, diarrhea or anepithymia,and tremor after conversion treatment was 13.4 ％ (13/97),2. 1％ (2/97) and 5. 2 ％ (5/97),respectively. There were no serious pulmonary infection and tumor during the observation period. Conclusion The mid-long term effect of conversion from CsA to Tac in patients with kidney transplantation is safe and effective.