肾移植2、3、5年患者的免疫抑制用药分析

A RETROSPECTIVE ANALYSIS OF DIFFERENT IMMUNOSUPPRESSIVE PROTOCOLS IN RENAL TRANSPLANTATION

目的：分析肾移植后免疫抑制剂对长期存活的影响，寻找移植后不同时间合适的免疫抑制用药方案及其用药剂量。方法：对肾移植一年以上、肾功能正常的４９７例患者进行５年连续随访。根据移植后２、３、５年的不同免疫抑制用药将患者分为三联、二联、传统二联治疗三组。统计各组的排异发生率，排异和无排异患者免疫抑制用药的种类、剂量及ＣｓＡ浓度，对排异患者追踪排异发生前１２个月内的药物更动情况。结果：肾移植后２、３、５年的三联治疗排异率分别为４．９４％、４．９３％和５．６５％。传统二联治疗为７．６９％、１２．３５％和５．１０％。三联治疗的排异发生率明显低于传统二联治疗（Ｐ＜０．０５）。绝大多数排异患者有ＣｓＡ或Ａｚａ停药或减量史。结论：肾移植后三联治疗是维持治疗的最佳方案，停用或减少ＣｓＡ是导致排异发生的主要原因。

OBJECTIVE Different protocols of immunosuppression have been used for renal transplantation with the combination of cyclosporine A(CsA) or Azothioprine(Aza) or prednison (P). To compare the long term effects of different protocols in renal transplantation patients, we retrospectively analyzed the data of our patients whose renal grafts maintained normal for at least one year. METHODOLOGY 497 renal graft recipients were included. All of them were followed up for more than five years and serum creatinine maintained normal for at least one year. The patients were divided into three groups, triple therapy(CsA+Aza+P), double therapy(CsA+P) and traditional combined therapy (Aza+P). The rates of allograft rejection for 2, 3 and 5 years were compared between the three groups, and comparison was made between patients with and without rejection in regarding to the immunosuppression protocol changes. RESULTS Allograft rejection rates of 2, 3 and 5 years post transplantation were respectively 4 95%( n =243), 4 93% ( n =223)and 5 65%( n =124) for triple therapy; 30%( n =10), 8%( n =25), 5 26%( n =38) for double therapy; and 7 69%( n =91), 12 35%( n =81), 5 10% ( n =98) for traditional combined therapy. In the analysis of the data from patients with rejection, we found most of them had a history of inadequate dosage tapering or withdrawal of CsA or Aza. CONCLUSION Triple therapy is the best immunosuppressive maintaining regimen. The most common cause of graft rejection was inadequate dosage tapering or withdrawal of CsA or Aza.