用他克莫司替换环孢素A预防和治疗肾移植后慢性移植肾肾病

目的 观察用他克莫司（FK506）替换环孢素A（CsA）预防和治疗肾移植术后慢性移植肾肾病的有效性和安全性。方法 回顾性分析36例肾移植术后移植肾功能异常，病理检查确诊为慢性移植肾肾病（CAN）患者的临床资料。所有患者术后均采用以CsA为主的免疫抑制方案，临床确诊为CAN后，用FKS06替换CsA。FK506的起始剂量为原CsA剂量的1／50～1／100，维持剂量则根据患者的体重、发病情况、肾移植时间及FK506的血药谷值浓度确定，其他免疫抑制剂用量不变。观察换药后的移植肾功能变化，同时监测血糖、血脂和FK506的血药浓度。结果 用FK506替换治疗6个月后，患者的移植肾功能较替换前明显好转（P＜0．05），胆固醇、甘油三酯较替换前降低（P＜0．05），但血糖升高，出现新发糖尿病2例。结论 用FK506替换CsA可改善移植肾功能，提高移植肾的长期存活率。

Conversion from cyclosporine to tacrolimus for the treatment of chronic allograft nephropathy

Objective To assess the effect of immunosuppression conversion from cyclosporine(CsA) to tacrolimus(FK506) on progression of chronic allograft nephropathy(CAN).Methods A retrospective study was performed in 36 cyclosporine treated renal transplant recipients.Patients were included if they were biopsy-proven CAN and they were converted from cyclosporine to tacrolimus due to CAN.The FK506 dose was 1/50 to 1/100 of the cyclosporine's and the dose was adjusted according to the trough level of tacrolimus,body weight of the patient and the situation of CAN.Other immunosuppressive agents kept unchanging.Serum creatinine and FK506 trough level were monitored after conversion.Fasting blood triglyceride,total cholesterol and glucose were determined at baseline and 6th month after conversion to tacrolimus.Results After switching over to FK506 for 6 months,there was a significant improvement in function of renal allograf(P<(0.05)).Triglyceride and cholesterol were decreased concomitantly(P<(0.05)) and diabetes mellitus were onset in 2 cases.Conclusion Conversion from CsA to FK506 can be an alternative strategy in kidney transplant patients suffering from CAN and can improve long-term allograft and patient survival.