肝移植术后西罗莫司的替换治疗

目的 探讨肝移植术后应用西罗莫司的抗排斥替换治疗效果。方法 回顾性分析50例肝移植或肝肾联合移植患者替换西罗莫司前后肝肾功能的改善情况及副作用和排斥反应的发生率。34例联合应用小剂量FK506，9例联合应用骁悉，2例联合应用新山地明。5例术后远期患者，替换前仅用FK506，替换后单用西罗莫司。结果 24例患者因肝功能不良而替换西罗莫司，其中16例（66．7％）肝功能明显改善；18例患者肾功能不良，其中13例（72．2％）在2个月内肾功能明显好转；8例患者因大剂量应用FK506但其浓度未达到6ng／ml而替换西罗莫司，移植术后肝肾功能恢复良好，未出现排斥反应。本组中应用西罗莫司后出现急性排斥反应3例（6％），改用FK506后急性排斥反应治愈。11例（22％）出现白细胞及血小板减少，9例（18％）胆固醇和甘油三酯升高。这些副作用均在西罗莫司应用1月后出现，当停药或对症处理后消失。本组中未出现肝动脉血栓形成、伤口愈合不良等并发症。结论 肝移植术后应用钙调磷酸酶抑制剂发生肝肾功能不良或不能达到理想药物浓度时，西罗莫司是有效的抗排斥替代药物。

Sirolimus-based immunosuppression in orthotopic liver transplant recipients with liver or renal insufficiency

Objective To evaluate sirolimus based immunosuppression therapy in orthotopic liver transplant recipients with compromised liver or renal functions. Methods Clinical data of 50 patients shifted to sirolimus regime in our center were analyzed retrospectively. The indication for sirolimus-based immunosuppression was calcineurin inhibitor-related liver and/or renal toxicity. A combination sirolimus and small dose of FK506 was adopted in 34 cases, combined with MMF in 9 cases, and with neoural in 2 cases. Five cases were on sirolimus only. Results When the use of immunosuppressant was shifted from a calcineurin inhibitor to sirolimus in the 24 recipients with liver dysfunction, live function was back to normal within 2 months in 16 cases. Renal function improved significantly in 13 of 18 recipients with renal insufficiency. With the new regime acute rejection developed in 3 cases, hyperlipidemia in 9 cases, leukopenia and thrombocytopenia in 11 cases. All those sirolimus associated complications disappeared one month after the regime on tacrolimus was resumed. There was no sirolimus-associated hepatic artery thrombosis in our group. Conclusion The appropriate conversion to sirolimus could be a life saving measure in recipients with liver or renal insufficiency after OLT.