肾移植术后长期应用环孢素2332例的临床远期随访?

目的：总结肾移植术后长期应用环孢素( CsA)的临床经验。方法分析接受首次肾移植、术后长期服用CsA 并维持随访的受者2332例。根据患者的年龄分为儿童组(<18岁)27例,成人组(18~60岁)2086例,高龄组(>60岁)219例,计算所有患者及分组的排斥反应发生率和1、3、5、10年人、肾存活率,并以成人组为对照,分别与儿童组、高龄组进行上述指标的比较。统计长期服用CsA不良反应的发生率。结果所有患者、儿童组、成人组以及高龄组急性排斥反应( AR)发生率分别为17．0%、40．7%、17．1%、13．2%,慢性排斥反应( CR)发生率相应为13．2%、29．6%、13．4%、9．1%；1、3、5、10年人、肾存活率分别为：所有患者97．0%/96．7%、93．2%/86．2%、88．4%/82．7%、83．4%/65．4%,儿童组96．3%/96．3%、92．6%/85．2%、88．9%/81．5%、81．5%/63．0%,成人组97．5%/96．9%、93．4%/86．1%、88．9%/82．8%、84．0%/65．3%以及高龄组94．5%/94．1%、91．8%/87．2%、83．6%/82．2%、78．1%/66．2%。儿童组AR、CR发生率高于成人组(P=0．003, P=0．022),但人/肾存活率与成人组比较差异无统计学意义(P=0．34, P=0．08)。高龄受者CR发生率低于成人组(P=0．035),生存率低于成人组(P=0．009),AR和移植肾存活率与成人组类似(P=0．074, P=0．28)。 CsA的不良反应有：肝功能损害(16．5%)、肾中毒(17．7%)、高脂血症(17．4%)、高血压(32．8%)、糖代谢异常(13．2%)、牙龈增生(35．7%)以及多毛(24．1%)等。通过减少 CsA剂量、免疫抑制剂联合用药、对症治疗等措施,多数患者症状消失或缓解。结论 CsA是一种安全、有效的免疫抑制剂,除可用于成人肾移植之外还可用于儿童及高龄受者。移植术前良好的HLA配型,CsA精准浓度调控以及联合用药有利于降低CsA剂量,从而减少CsA不良反应的发生。

Long-term outcomes of kidney transplantation in 2332 patients under cyclosporine A

Objective To investigate the long-term efficacy and safety for cyclosporine A ( CsA) in renal trans-plant recipients. Methods A total of 2332 kidney recipients were divided into three groups (1) children ( <18 years of age)(GI, n=27);(2) adults (18 to 60 ys) (GII, n=2 086); and (3) elderly recipients ( >60 ys) (GIII, n=219);Information was obtained on acute rejection (AR), chronic rejection (CR), side effect, patient and graft survival at 1, 3, 5 and 10 years. Data were compared among the three groups, with GII as the control group. Results At a mean follow up time of 87. 2 months, incidences of AR/CR for all patients and within each group were 17. 0%/13. 2%, 40. 7%/29. 6% (GI), 17. 1%/13. 4%(GII) and 13. 2%/9. 1%(GIII), respectively. Patient/graft survival at 1, 3, 5 and 10 years were 97. 0%/96. 7%, 93. 2%/86. 2%, 88. 4%/82. 7% and 83. 4%/65. 4% for all recipients; 96. 3%/96. 3%, 92. 6%/85. 2%, 88. 9%/81. 5% and 81. 5%/63. 0% for GI; 97. 5%/96. 9%, 93. 4%/86. 1%, 88. 9%/82. 8% and 84. 0%/65. 3% for GII and 94. 5%/94. 1%, 91. 8%/87. 2%, 83. 6%/82. 2% and 78. 1%/66. 2% for GI-II, respectively. Compared with GII, GI had higher AR and CR incidences (P=0. 003, P=0. 022), however, patient/graft survivals were similar (P=0. 34, P=0. 08). Compared with GII, CR incidence and patient survival were lower for GIII (P=0. 035, P=0. 009), but AR incidence and graft survival were similar between the two groups (P=0. 074, P=0. 28). The major long - term side effects associated with CsA - based immunosuppression include hepatoxicity (16. 5%), nephrotoxicity (17. 7%), hyperlipidemia (17. 4%), hypertension (32. 8%), impaired glucose metabolism (13. 2%), gingival hyperplasia (35. 7%) and hirsutism (24. 1%), etc. Most adverse effects were alleviated or elimina-ted by dose minimization of CsA, combination with other immunosuppressant agents and symptomatic treatments. Conclu-sion CsA is an effective immunosuppressive agent that is safe for long-term treatment in adult, pediatric and elderly pa-tients as well. Good HLA matching, precise adjustment for CsA dosage and combination with other immunosuppressant a-gents allow for a reduction of CsA dosing and therefore lead to a reduction of CsA-related toxic effects.