肝炎病毒携带者肾移植术后他克莫司的应用体会

目的：探讨肝炎病毒携带者肾移植术后应用他克莫司（FK506）的临床意义。方法：将59例肾移植受者（年龄＜55岁）分为两组，即肝炎病毒 携带者组（21例）和非肝炎病毒携带者组（38例）。观察肝炎病毒携带者和非肝炎病毒携带者肾移植术后应用FK506初始剂量的血药浓度，以及术后3个月，半年维持剂量的变化，并观察肝功能和急、慢性排斥反应的发生情况。结果；在相似的初始剂量下，肝炎病毒携带者组FK506血药浓度明显高于非携带者组，而且术后3个月及半年FK506维持剂量又明显低于非携带者组；术后3个月两组各有2例肝功能异常；随着观察时间的延长，有15例非肝炎病毒携带者因血药浓度偏低和维持剂量一直偏高，难以承担昂贵药费或发生急、慢性排斥反应，先后改用环孢素A。结论：肝炎病毒携带者肾移植术后免疫抑制剂应首选FK506，既减轻和避免药物副作用，药费也相对较低。

Application of tacrolimus (FK506)-based immunosuppression in hepatitis virus carriers following renal transplantation

Objective To study clinical application of FK506-based immunosuppression in hepatitis virus (HV) carriers following renal transplantation. Methods Fifty-nine patients (<55 years) were divided into 2 groups:HVgroup and non-HV group. The FK506 blood concentration of initial dosage, the changes of maintenance dosage, as well as hepatic dysfunction and acute or chronic rejection were observed. Results Under the similar initial dosages , blood concentrations of FK506 in HV group were significantly higher than in non-HV group, but maintenance dosages of FK506 in HV group were markedly lower 3 months or 6 months after renal transplantation than in non-HV group. In the non-HV group, 15 cases converted FK506 to CsA due to acute rejection (4 cases), chronic rejection (2 case) and expensive medicine charge with the investigation going on. Conclusions FK506 may be the first choice for HV carriers following renal transplantation. Not only could side effects be avoided, but also was expense not increased relatively.