FK 506与CsA在肾移植术后抗排斥的临床应用

 目的 比较研究他克莫司(FK 506)与环孢素A(CsA)预防肾移植术后排斥反应的效果和安全性。方法 肾移植患者53例分成两组，FK506始用组为28例，CsA始用组为25例。FK506起始用每d0.2mg／kg，CsA起始用每d6mg／kg，用时合并应用MMF0.75g，2／d，以及术后3d大剂量甲基强的松龙(MP)静滴，第3d改强的松口服。结果 FK506始用组移植肾功能好，平均7.5d肌酐水平平均降至99.5μmol／L，2例出现排斥反应，经MP连续3d冲击后治愈，CsA始用组19例移植肾功能良好。结论 肾移植术后应用FK506疗效确切，能有效防治难治性排斥的发生，降低急性排斥的发生率，特别是乙肝表面抗原阳性 肝功能受损者比CsA优越。

Clinical use of FK 506 and CsA in renal transplant recipients

Objective To compare the effect iveness and safety of tacrolimus (FK 506) with cyclosporin A(CsA) in the prevention of rejection of renal transplantation.Methods A total of 53 cases of cadaveric kidney transplant recipients were randomly divided into two groups:group A(28) received FK 506,MMF and pred nisone;group B received CsA,MMF and pred nisone.In group B,3 cases for the reason of hepatoxicity and one for refractory acute rejection were administered CsA changed to FK 506.Results In group A,the renal function became normal in an average of 7.5 days;acute rejection occurred in 2 cases,all recovered on appropriate management.In group B,the renal function recovered nicely in 19 case.acute rejection occurred in 6,of whom 4 changed from CsA to FK 506 for the reason of refractory acute rejection and hepatoxicity.In FK 506 group,the hyperglycosemia occurred in 6(18.8%),hypertension in 5(15.6%) and infection in 7( 21.9% ).In CsA group,hyperglycosemia occurred in 2(9.5%),hypertension in 5(23.8%) and infection in 4(19.0%).Conclusions FK 506 is a safe and effective immunosuppressive agent in renal transplant;it can prevent and treat refractory acute rejection and decrease the episodes of acute rejection.It is better than CsA in patients with abnormal liver function and positive HBsAg.