西罗莫司治疗心脏死亡器官捐献肾移植术后急性排斥反应(附1例报告并文献复习)

目的探讨西罗莫司在心脏死亡器官捐献(donation after cardiac death,DCD)肾移植术后急性排斥反应中的应用。方法回顾性分析1例接受同种异体DCD供肾受者肾移植术后发生急性排斥反应,早期应用西罗莫司治疗的临床资料并复习相关文献。结果 1例DCD供肾肾移植受者,采用他克莫司(FK506)+吗替麦考酚酯(MMF)+泼尼松三联抗排斥免疫方案(FK506每次3mg,每日2次;MMF每次750mg,每日2次;泼尼松每次15mg,每日1次),术后即出现无尿,诊断为移植物功能延迟恢复(DGF)。行血液透析治疗,每周3次。术后35d发现尿量减少,移植肾彩色多普勒超声提示急性排斥反应,经肾上腺皮质激素冲击治疗无效后,血清肌酐(Scr)升高,提示治疗无效,改为西罗莫司+FK506+MMF+泼尼松的四联方案(西罗莫司每次0.5mg,每日1次;FK506每次2mg,每日2次;MMF每次250mg,每日2次;泼尼松每次15mg,每日1次),并减少他克莫司剂量。改用方案后3d患者Scr逐渐下降至正常,至出院后未再出现排斥反应。患者随访至2013年4月移植肾功能稳定,生活质量良好。结论西罗莫司有利于DCD供肾肾移植患者肾功能早期恢复,对术后急性排斥反应有一定疗效。

Sirolimus for acute rejection after renal transplantation from donation after cardiac death: a case report and literature review

Objective To investigate the application of sirolimus （SRL） in treating patients with acute rejection （AR） after renal transplantation from donors after cardiac death （DCD）. Methods Clinical data of the recipient, who developed AR after DCD renal transplantation and took SRL as early treatment, were retrospectively analyzed and the related literatures were reviewed. Results The DCD renal transplant recipient received a tripe anti-rejection immunosuppression regimen of tacrolimus （FK506）, mycophenolate mofetil （MMF） and prednisone （pred） （FK506：3 mg, twice a day; MMF： 750 mg, twice a day; pred： 15 rag, once a day）. The patient was diagnosed as delayed graft function （DGF） for the immediate occurrence of anuria after transplantation. Hemodialysis treatment was performed three times every week. The urine volume decreased on day 35 after transplantation and the color Doppler ultrasound of transplant kidney indicated the occurrence of AR. The serum creatinine （Scr） increased after the shock therapy of adrenocortical hormone, which indicated ineffective treatment. SRL was added in the immunosuppression regimen to be a tetragenous one： SRL, FK506, MMF and pred with the decrease of FK506 dosage （SRL：0. 5 mg, once a day; FK506： 2 mg, twice a day; MMF： 250 mg, twice a day; pred： 15 mg, once a day）. At day 3 after changing theregimen, the level of Scr gradually decreased to normal level and there was no AR observed after the patient discharged from hospital. The patient was followed up that had a good quality of life with stable transplant renal function until April 2013. Conclusions SRL is useful for the early recovery of renal function of patients after DCD renal transplantation and is effective in treating AR after transplantation.