肝移植术后真菌感染患者免疫抑制方案的调整

目的 探讨肝移植术后真菌感染患者的免疫抑制方案。方法 我院器官移植中心从2004年1月至2005年12月实施376例成人肝移植，对术前、术中存在真菌感染危险冈素的59例患者采用IL-2（interleukin-2）受体单克隆抗体诱导方案，对术后发生真菌感染的患者在应用有效抗真菌药物的同时，调整其免疫抑制方案。结果 共有36例患者发生真菌感染，发生真菌感染的中位时间为术后19d（4～75d），其中无临床症状仅真菌培养阳性16例，20例患者出现临床感染症状，感染部位以呼吸道（11/20，55%）为主，4例患者死于严重感染。真菌菌株培养多为白色念珠菌（24/41，58.5%）。16例患者减少免疫抑制剂，20例有临床表现的患者停用免疫抑制剂，减药或停药过程中仅1例患者出现排斥反应。结论 真菌感染是肝移植术后的重要并发症，术前或术中存在真菌易感因素患者应采用IL-2受体单克隆抗体诱导方案，术后发生真菌感染的患者在应用有效抗真菌药物同时，应减少或停用免疫抑制药物。

The immunosuppressive strategy for liver transplant recipients with fungal infection

Objective To evaluate the role of immunosuppressive strategy adjustment in the management of liver transplant recipients with fungal infection. Method Clinical data of 376 adult liver transplant recipients in our center was retrospectively analyzed. Recipients with the risk factors for fungal infection before and during the operation received the immunosuppressive treatment with IL-2 receptor monoclone antibody introduction, immunosuppressive drugs were reduced or withdrawn in patients with fungus infection after the operation. Results Thirty-six recipients developed fungal infection on a median course of 19 d after liver transplantation. There were 16 asymptomatic patients with only positive fungal culture who were treated with reduced dosage of immunosuppressive. Immunosuppressants were withdrawn in 20 recipients with clinical infection symptoms, leading to acute rejection in 1 patient. Four patients died of severe infection. Conclusion Fungal infection is a severe complication with high mortality rate after liver transplantation; the arrangement of immunosuppressive agents is important to improve the outcome, which is not associated with high incidence of acute rejection.