西罗莫司在肝移植后并发他克莫司所致肾功能损害患者中的应用

Sirolimus as primary immunosuppression for calcineurin inhibitor-related renal insufficiency following liver transplantation

目的探讨肝移植后并发他克莫司（FKS06）所致肾功能损害时使用西罗莫司的有效性和安全性。方法13例患者肝移植术后均采用以FK506为主的免疫抑制方案预防排斥反应，发生肾功能损害后，停用FK506，或FK506用量减半，同时加用西罗莫司。治疗期间监测患者的血肌酐和尿素氮水平、血西罗莫司和FK506浓度、肝脏功能及排斥反应的发生情况。结果所有患者在使用西罗莫司后肾脏功能迅速改善，血肌酐水平由（147．6±92．8）umol／L降到（106．1±71．6）μmol／L（P〈0．05）；除1例发生急性排斥反应外，其余患者在治疗期间均未发生排斥反应；用药期间的不良反应有高脂血症（4例）及白细胞减少（2例），经对症处理好转。迄今随访4～15个月，肾功能未再出现异常。结论肝移植术后发生药物性肾功能损害时，使用西罗莫司治疗是安全和有效的。

Objective To evaluate efficiency and safety of sirolimus in preserving renal function in patients with renal insufficiency by tacrolimus after liver transplantation. Methods Tacrolimus as primary immunosuppression was used in 13 patients after liver transplantation. Patients with a creatinine level higher than 132.6 tLmol/L were eligible for conversion to sirolimus. Simultaneously, dose of tacrolirnus was decreased to half dose. BUN, creatinine, tacrolimus level, liver function and rejection episode were monitored dynamically. Results All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from （147. 6 ± 92. 8） μmol/L to （106. 1 ± 71.6） μmol/L （P〈0. 05）. One patient had acute rejection episode that was successfully treated with pulse corticosteroids and low-dose tacrolimus. Side-effects of sirolimus included hyperlipemia （4 cases） and leukocytopenia （2 patients）. Conclusion Sirolimus can be safely used in OLT recipients with renal insufficiency caused by tacrolimus.