肾移植术后肝肾功能损害患者应用他克莫司切换环孢素的临床观察

目的观察他克莫司切换环孢素A治疗肾移植术后肝、肾功能损害患者的安全性及临床疗效。方法将33例肾移植术后肝、肾功能异常的患者分为4组：术后直接使用他克莫司组（Ⅰ组,8例）;术后1年内切换他克莫司组（Ⅱ组,9例）;术后2～4年切换他克莫司组（Ⅲ组,9例）;术后5年以上切换他克莫司组（Ⅳ组,7例）。观察用他克莫司替换环孢素A12、24个月后各组患者肝、肾功能的变化情况。结果肾移植术后1年内切换他克莫司的患者,切换12个月时血肌酐由切换前的（133.21±40.92）μmol·L-1降至（116.86±35.41）μmol·L-1,呈明显下降趋势,但差异无统计学意义;移植术后2～4年切换他克莫司的患者,切换24个月时,患者的血肌酐由（138.00±15.72）μmol·L-1降至（109.76±9.68）μmol·L-1,下降较显著（P〈0.05）,差异有统计学意义;术后5年以上切换他克莫司患者,切换12个月时,血肌酐变化不大,差异无统计学意义。结论用他克莫司替换环孢素A治疗肾移植术后肝、肾功能损害是一种安全而有效的措施。

Clinical Study of CsA Substituted by Tacrolinus in Recipients with Hepatic and/or Renal Dysfunction After Kidney Transplantation

Objective To evaluate the therapeutic efficacy and safety of CsA substituted by tacrolinus （FK506） in renal allograft recipients with hepatic and/or renal dysfunction. Methods 33 cases of renal allograft re- cipients with hepatic and/or renal dysfunction were divided into four guoups ： the first group consisted of recipients who used FK506 directly after kidney transplantation （ n = 8 ） ;the second group was composed of recipients who had CsA substituted by FK506 one year after kidney transplantation （ n = 9 ） ;the third group two-four years after kidney transplantation （ n = 9） and the fourth group more than five years after kidney transplantation （ n = 7）. The changes of hepatic and renal function were observed for 12 or 24 monthes in all the recipients. Results Twelve months after conversion from CsA to FKS06 in recipients of the second group, the level of serum creatinine（ μmol L - 1 ） decreased significantly from 133.21 ± 40.92 to 116.86 ± 35.41, but of no statistic significance. After twen- ty-four months the level of serum creatinine（ μmol L-1 ） decreased significantly （ P 〈0.05 ） from 138.00 ±15.72 to 109.76 ± 9.68 in the third group. There was no significantly different in the level of serum creatinine in recipi- ents of the fourth group after twelve months. Conclusion FK506 substitution of CsA is an effective and safe approach to hepatic and/or graft dysfunction which occurs in renal allograft recipeients.