异体手移植术及其免疫抑制治疗(附2例报告)

目的 探讨异体手移植术及免疫抑制治疗的效果。方法 术前2 d受者开始服用免疫抑制剂霉酚酸酯（MMF）、他莫克司（FK506）、泼尼松（Pred），术中甲泼尼龙（MP）1.5 g冲击，术后第1天甲泼尼龙1.0 g冲击，并开始应用抗胸腺细胞球蛋白(ATG)100 mg/d×10 d，术后12 h口服FK506、MMF、Pred，观察移植肢体血液循环温度、排斥情况，同时监测FK506血浓度及免疫学指标。结果 术前、术中及术后应用免疫抑制剂后未见异体手排斥现象。2例移植手血循环良好，皮肤切口顺利愈合，术后10 d拆线。Tinel征检查显示神经生长速度较快，术后半年移植手功能良好，感觉已恢复至手指末节，可以持物，肌电图显示鱼际肌已见动作电位。1例应用FK506后出现血糖升高，应用胰岛素治疗后血糖降至正常。结论 良好的组织配型、免疫抑制剂的合理应用可以预防异体手移植的超急性、加速及急性排斥反应的发生。

Human hand allograft and the immunosuppression regimen ( report of 2 cases)

Objective To explore the effect of immunosuppressive therapy on the outcome of hand allograft. Methods The recipients were given MMF, FK506, prednisone 2 d before operation, and were treated with pulse doses of 1 500 mg methylprednisolone intravenously during the operation. Since the first day after the operation, immunosuppressive therapy with ATG (100 mg/d for 10 d), FK506, MMF, prednisone was prescribed. Clinical observations were made of the blood circulation, the temperature of the graft, and the symptoms of graft rejection. Whole blood FK506 concentrations and relevant immunololgical indexes were also monitored. Results Allograft rejection was not observed in the 2 patients. The circulation of the transplanted hands was satisfactory. The skin incision healed smoothly, and rapid nerve regeneration was detected by observing ' Tinel' sign. After 6 months, the function of the graft recovered which could afford holding a drinking cup. The nerves had grown to the end of the fingers and eletromyograph showed regenerative action potentials in the thenal muscles. One of the patients developed hyperglycaemia because of FK506's administration, and was corrected with timely insulin therapy. Conclusions Hyperacute, acute and accelerating rejection can be prevented by skilled transplant technique, good tissue matching and combined use of currently available immunosuppressants. The recovered functions of the allograft at an early stage can be comparable with that of autologous transplantation.