他克莫司联合霉酚酸酯应用于胰肾联合移植的初步经验

目的 总结他克莫司(FK506)联合霉酚酸酯(MMF)应用于胰液膀胱引流式胰肾联合移植受者的初步经验. 方法 胰肾联合移植患者14例,术后应用FK506 0.07～0.15mg·kg-1·d-1加MMF 1.0～1.5 g/d加泼尼松25 mg/d三联免疫抑制治疗方案.采用微粒子酶免疫分析法每周测定口服FK506后全血峰谷浓度,依此调整剂量维持最初3个月内FK506全血浓度峰值10～20 μg/L,谷值5～15μg/L.并观察排斥反应的发生及药物的肝肾毒性. 结果 9例患者术后胰肾功能恢复良好,早期无排斥反应发生,血糖及肌酐水平恢复正常.随访18～70个月,平均34个月.存活1～3年者3例,3年～者1例,4年～者1例,>5年者4例,胰肾功能良好,血糖正常,均未使用降糖药.1例因超急性排斥反应术后第2天切除移植胰腺,随访2年肾功能良好.4例死亡,死因分别为术后急性右心功能衰竭、呼吸骤停、急性排斥反应及十二指肠瘘.胰肾联合移植术后各时期FK506全血峰、谷浓度差异均有统计学意义(P<0.05).术后共发生肾脏急性排斥反应4例次,肾毒性2例次,肝毒性1例次. 结论 FK506与MMF在药效上有协同作用,联合应用于胰肾联合移植具有良好的免疫抑制效果,能有效降低排斥反应发生率和提高移植物长期存活率.

Application of combined tacrolimus and mycophenolate mofetil in simultaneous kidney-pancreas transplantation

Objective To evaluate the clinical experience of applying the combined tacrolimus (FK506) and mycophenolate mofetil (MMF) in simultaneous pancreas and kidney transplantation (SPKT) with bladder drainage of pancreatic secretion. Methods SPKT was performed for 14 consecutive patients. On the first day after transplantation, triple immunosuppression therapy was applied with FK506(0.07-0. 15 mg·kg-1·d-1), MMF(1.0- 1.5 g/d) and prednisone (25 mg/d). The FKS06 blood concentration after oral administration was assayed by the means of MEIA. The occurrence of rejection and the drug toxicity were monitored and recorded. Results Nine recipients survived with the grafts and their general conditions were well. They were followed up for 18--70 months (mean 34 months). There was no early stage complication such as pancreatic fistula and thrombosis after operation. The blood glucose level returned to normal range after operation. All recipients survived over 1 year. Of them, 3 cases survived for 1-3 years,1 case survived for 3-4 years, 1 case survived 4-5 years and 4 cases survived over 5 years. All the cases had normal blood glucose level and early graft function. Removal of allograft pancreas was performed on one patient because of hyperacute rejection. There were 4 cases died. Of whom, one case was diagnosed with duodenal stump leak 45 days after transplantation and he died of corrosive hemorrhage 7 months after operation. One patient died of unexpected heart disease. The 3rd patient died ol multiple organ failure and the fourth case died of acute rejection. Four cases with acute rejection, 2 cases with renal toxicity and 1 case with hepatotoxicity were observed. Conclusions The combination of TAC/MMF has synergetic effect. The application of this combination has good immunosuppression result. It could effectively reduce the risk of acute rejection and improve graft survival in SPKT recipients.