他克莫司治疗肾移植术后难治性排斥反应的临床观察

Clinical effect of tacrolimus(FK506) on the treatment of refractory rejection after kidney transplantation

目的 观察他克莫司 (FK5 0 6 )替换环孢素A(CsA)治疗肾移植术后难治性急性排斥反应的有效性和安全性。方法 18例肾移植患者应用CsA后出现急性排斥反应 ,给予甲泼尼龙 (MP)冲击治疗和单克隆抗体或抗胸腺细胞球蛋白 ,治疗无效后改用FK5 0 6治疗 ,根据血中浓度调整FK5 0 6用量 ,FK5 0 6浓度维持在 8～ 12 μg/L左右 ,免疫及生化指标逐渐好转为治疗有效。结果 18例患者改用FK5 0 6后 16例在 9～ 18d急性排斥得到逆转 ,肾功能恢复正常 ,2例治疗无效。随访 6 0～ 35 0d ,16例患者肾功能保持持续稳定 ,3例出现高血糖。结论 FK5 0 6替换CsA治疗肾移植术后难治性急性排斥反应是安全、有效的。

Objective To evaluate the efficacy and safety of conversion from cyclosporine(CsA) to FK506 in the treatment of clinical refractory rejection of renal allografts. Methods Eighteen patients with acute rejection after kidney transplantation not MP and monoclonal(OKT 3) or polyclonal antilymphocyte(ATG) preparation received the treatment of FK506 substituting for CsA. Dose of FK506 was subsequently adjusted to maintain whole blood trough levels between 8～12 ug/L. Results 16 of 18 patients had resistant rejection successfully rescued within 9～18 days after conversion to FK506 therapy. Serum creatinine significantly decreased. 2 patients failed. Hyperglycemia occurred in 3 cases. Conclusion Conversion from cyclosporine-based regimen to FK506-based regimen is an effective and safe alternative for rescuing resistant rejection of renal allografts.