儿童肾移植临床免疫抑制用药探讨

Immunosuppressive therapy in pediatric cadaveric renal transplantation

目的 探讨儿童肾移植免疫抑制治疗特点。方法 回顾性分析 31例儿童肾移植患者(男 18例,女 13例)的临床资料。根据起始免疫抑制方案不同,分为 3组:A组(环孢素A+硫唑嘌呤+泼尼松)7例;B组(环孢素A+霉酚酸酯 +泼尼松)17例;C组 (他克莫司 +霉酚酸酯 +泼尼松)7例。统计 3组免疫抑制药物调整及维持剂量、移植肾功能变化和术后并发症。结果 1年人 /肾存活率为100% /96.8%,3年人 /肾生存率为94.4% /88.9%。三组各观察点肌酐实测值差异无显著性意义 (P<0.05)。他克莫司组药物副作用小且能保持良好的肾功能。泼尼松调整幅度大、维持量小,与其他组差异有显著性意义(P<0.01)。结论 肾移植是儿童终末期肾病的有效治疗措施。遵循儿童个体差异的免疫抑制治疗是移植后预防排斥的重点。他克莫司、霉酚酸酯、泼尼松三联抗排斥治疗是儿童肾移植理想的免疫抑制治疗方案。

Objective To sum up the experience of immunosuppressive therapy of renal transplantation in children.Methods The clinical data of application of immunosuppressive drugs and their concomitant complications in 31 cases(aged less than 18 years, 18 boys and 13 girls)were retrospectively analyzed. Thirty-one recipients were divided into 3 groups in terms of the initial immunosuppressive regimes used: group A(7 cases) receiving cyclosporine,azathioprine and steroid; group B(17 cases) receiving cyclosporine,mycophenolate mofetil (MMF) and steroid; group C(7 cases) receiving tacrolimus(FK506), MMF and steroid. The data of the recovery of renal function, changes of immunosuppressive agents, incidences of side effect and related complications were analyzed in each group.Results One-year person/graft survival rates were 100%/ 96.8% while three-year person/graft survival rates were 94.4%/ 88.9%. There were no significant difference of levels of serum creatinine among three groups(P > 0.05).Tapering of prednisone was employed in children receiving FK-506 who experienced minor rejection episodes and good renal function during the 1st post-transplant year. The dose of the prednisone in the FK506 group was significantly lower than that in the other groups (P< 0.01). Post-transplant side effects of FK506 were significantly less than those of cyclosporine.Conclusions Combined use of FK506, MMF and Prednisone is an ideal regimen of immunosuppressive therapy for renal transplant in children.