中国组织工程研究与临床康复2009，Vol.13Issue(44)：8749-8752,4.DOI:10.3969/j.issn.1673-8225.2009.44.034
肾移植后雷帕霉素免疫抑制剂转换方案应用12例
Rapamycin combined immunosuppression for 12 renal transplant recipients
王强 1蔡明 1石炳毅 1钱叶勇 1李州利 1李晓利 2金海龙 1梁涛1
作者信息
- 1. 解放军总医院第二附属医院泌尿外科,北京市,100091
- 2. 解放军总医院第二附属医院干部病房,北京市,100091
- 折叠
摘要
Abstract
OBJECTIVE:To analyze and summarize the initial experience of rapamycin combined immunosuppression(SRL)used in renal transplant recipients.METHODS:A retrospective analysis was performed on 12 cases who were cured by SRL-based immunosuppression instead of calcineurin(CNI)-based immunosuppression due to acute rejection,allograft nephropathy,liver dysfunction,and gingival hyperplasia between January 2008 and June 2009.The selection of immunosuppression was as follows:①rapid conversion:calcineurin was reduced by 50%at the first day,and terminated at 1 week;4 mg SRL and maintained to 2 mg;②mycophenolate was terminated at the first day,while calcineurin was maintained or reduced by 50%;4 mg SRL and maintained to 2 mg;blood drug level was detected 5 days later to adjust drugs.RESULTS:Four of five patients with rapid metabolism were subjected to strategy 2,and creatinine was reduced 30 μmol/L;FK/CsA+SRL were adjusted to the target concentration,with no rejection.One of them was cured after lung infection.One case,who was treated by CNI-based immunosuppression,showed the visible short-term decline in creatinine after the conversion and then severe diarrhea and bad sense of treatment,ultimately resulting in the renal graft failure.One case was subjected to the first conversion strategy due to abnormal liver function.The liver function recovered after 2 months;3 cases was subjected to the first conversion strategy due to increasing creatinine,and the creatinine reduced 23 μmol/L fter 2 months and maintained at that level,but proteinuria of one cases was significantly increased.Two cases selected the first conversion strategy due to gingival hyperplasia,and the symptoms were significantly improved after 3 months with stable serum creatinine;1 case showed hypersplenism,and developed severe bone marrow suppression following oral administration of cyclosporine or tacrolimus at target concentration.The symptom was improved,and serum creatinine kept stable after 3 months of the first conversion strategy.Three cases had varying elevated degrees of blood lipids,and 9 cases had no significant increase in blood lipids.CONCLUSION:For renal transplant patients with rapid metabolism,the conversion to SRL is recommended.An effective anti-rejection drug concentration was mainly maintained through three times of oral anti-rejection drugs;meanwhile,the concentration increase of CNI-type anti-rejection drug is conducive to correcting and preventing rejection.Acute rejection is not an absolute contraindication after conversion to SRL,but after converted to SRL,CNI concentration should be maintained at a relatively high concentration,to maintain effective anti-rejection effect.关键词
肾移植/雷帕霉素/药物转换分类
临床医学引用本文复制引用
王强,蔡明,石炳毅,钱叶勇,李州利,李晓利,金海龙,梁涛..肾移植后雷帕霉素免疫抑制剂转换方案应用12例[J].中国组织工程研究与临床康复,2009,13(44):8749-8752,4.
