肝移植术后免疫抑制剂的替换应用

目的 探讨和总结肝脏移植术后免疫抑制剂的替换应用情况和经验。方法 回顾性分析我院1993年4月－2001年7月施行的67例肝脏移植，对48例早期肝移植患者中发生的免疫抑制剂替换应用情况进行总结。结果 48例患者中，21例（43．8％）因术后出现排斥反应或严重毒副作用而替换为其它免疫抑制方案。环孢素A（CsA 硫唑嘌呤（Aza)＋激素方案组（31例）中，15例（48．4％）进行替换；CsA 霉酚酸酯（MMF）＋激素组（14例）中，6例（43％）进行替换。发生排斥反应者常规应用激素冲击治疗，同时替换免疫抑制剂，将CsA替换为他克莫司（FK506）或提高CsA剂量，可获得有效控制；出现药物性肝损害者应及时减少CsA用量或成FK506，其肝功能多能改善；出现肾功能损害者应减少CsA用量并改联用MMF，或替换成FK506后可有效挽救肾功能；白细胞减少或严重感染者，应停用Aza或MMF，或将CsA改为FK506后可有效挽救肾功能；白细胞减少或严重感染者，应停用Aza或MMF，或将CsA改为FK506；神经系统病变经更换免疫抑制剂可以好转。结论 合理应用免疫抑制剂是提高肝移植成功率的关键之一；治疗中应视具体情况及时、果断、合理地转换免疫抑制剂，可以有效控制排斥反应、毒副作用及相关并发症，提高移植肝的存活率。

Altered use of immunosuppressants following orthotopic liver transplantation

To analyze the altered use of immunosuppressants in the recipients following orthotopic liver transplantation. Methods The clinical data of altered use of immunosuppressants in 48 recipients from 67 patients undergoing liver transplantation consecutively between April 1993 and July 2001 were analyzed retrospectively. Results Immunosuppressant strategy conversion due to rejection or side-effect occurred in 21 of 48 cases (43.8 %), including 15 of 31 cases (48.4 %) receiving CsA +Aza +corti-costeroid strategy and 6 of 14 cases (43 % ) receiving CsA+ MMF+ corticosteroid strategy. There was conversion for rejection in 8 cases, nephorotoxicity in 11 cases, hepatotoxicity in 4 cases, leukopenia in 7 cases, severe infection in 3 cases, and tremor in one case. Conclusion The timely and appropriate conversion of the immunasuppressive strategy is essential for the recipient and graft survival.