肾移植术后应用普乐可复替换环孢霉素A减轻药物毒副作用的临床观察

Clinical study of conversion use from CsA to tacrolimus to decrease side effects after kidney transplantation

目的:观察肾移植术后应用免疫抑制剂普乐可复(FK5 0 6 )替换环孢霉素A(CsA)以减轻CsA所致毒副作用的临床疗效。方法:分别对4 7例CsA肝中毒、15例高脂血症、5例牙龈增生、5例多毛症的肾移植患者用FK5 0 6替换CsA治疗。停用CsA 2 4h后开始给予FK5 0 6 ,初始剂量根据患者体重、肝功能损害程度及手术后的时间确定,服药后根据FK5 0 6谷值血药浓度调整剂量,术后半年内维持在8～10 μg/L ,术后1年6～8μg/L ,术后1年以上4～6 μg/L ,严密监测患者的肝肾功能、FK5 0 6血药浓度、血糖、血脂及临床表现。结果:4 7例CsA肝中毒的患者改用FK5 0 6后,4 5例分别在9～4 5d肝肾功能恢复正常,2例改用FK5 0 6后,肝肾功能仍无明显好转,经治疗无效而死亡。15例高脂血症的患者改用FK5 0 6治疗3个月后,血清总胆固醇水平明显降低。5例牙龈增生的患者在改用FK5 0 6后,牙龈增生均得到控制,其中3例恢复正常。5例因多毛影响外观的患者在改用FK5 0 6治疗后明显得到改善。结论:对应用CsA后出现严重的肝功能损害、多毛、牙龈增生及高血脂症的肾移植患者改用FK5 0 6是一种较好的补救办法,同时不增加排斥反应的发生率,而且副作用少。

Aim: To explore the clinical effect of conversion use from cyclosporin A(CsA) based on immunosuppression to the new agent tacrolimus (FK506) after kidney transplantation due to the side effects of CsA. Methods: Forty-seven patients transplanted who were diagnosed as having CsA hepatoxicity,15 patients with hyperlipidemia,5 patients with gingival overgrowth, and 5 patients with hirsuteness in whom FK506 substitute for CsA. The initial dose of FK506 were depended by the patient's weight,liver funtion and time of after operation. The dosage of FK506 was adjusted according to its trough level, and the levels of FK506 were sustained to 8～10 μg/L within 6 months after operation, 6～8 μg/L within one year and 4～6 μg/L later. Liver function, renal function, whole blood FK506 trough concentration serum lipids level, blood sugar and clinical symptoms were observed. Results: The liver function became normal in 45 of 47 patients of this group between 9 and 45 days. Only 2 patients died of liver failure after switched to FK506. Lipids levels decreased significantly in the recipients with hyperlipidemia after conversion to FK506. All of 5 patients experienced significant resolution of their gingival enlargement within the time period studied, however only 3 of them had complete regression. Five recipients with hirsutism benefited from replacing CsA with FK506, and were cured after the switch. Creatinine levels remained stable and no acute rejection was observed in the study. Conclusion: It is concluded that conversion from CsA to FK506 is effective to treat patients with hepatic dysfunction. A switch to FK506 is a safe alternative in cases of hyperlipidemia or hirsuteness after renal transplantation. It is also concluded that conversion for kidney transplantation patients with gingival overgrowth from CsA to FK506 can provide an effective management strategy for this clinical problem. The conversion from CsA based on immunosuppression to FK506 is safe and effective in renal transplant recipients with less side effects.