转换西罗莫司治疗肾移植后高胆红素血症的临床观察

Clinical observation of conversion from sirolimus therapy in renal transplantation recipients with hyperbilirubinemia

目的:对转换西罗莫司(SRL)并撤除钙调磷酸酶抑制剂(CNI)类药物对高胆红素血症影响及其安全性和可行性进行临床观察。方法:2006年2月～2007年11月对肾移植后伴有高胆红素血症患者37例转换SRL并撤除CNI类药物,观察转换后总胆红素(TB)水平变化、血清肌酐(Scr)变化和不良事件发生情况。结果: TB和直接胆红素(DB)由转换前的30.45μmol/L和10.10μmol/L下降至转换后的12.13μmol/L和3.7μmol/ L(P<0.01)。Scr和血尿酸(Ua)转换后较转换前均有较明显降低,肌酐清除率(Ccr)有所提高。移植肾和患者全部存活。不良事件主要为高脂血症。结论:转换SRL治疗肾移植后高胆红素血症是有效和安全的。

Objective：To evaluate the safety and efficacy of conversion from Calcineurin inhibitor（CNI）-based to Sirolimus （SRL）-based therapy in renal transplantation recipients with hyperbilirubinemia. Methods： 37 renal transplant recipients with hyperbiliruhinemia were enrolled. All the patients withdrew CNI and received sirolimus- based therapy. All the patients were followed up to observe the changes of serum total bilirubin（TB）, serum cre atinine（Scr） and incidences of adverse events. Results： After conversion, mean TB level decreased from 30.45 μmol/L to 12.13μmol/L, and mean direct bilirubin （DB） level decreased from 10.10μmol/Lto 3.7 μmol/L（P〈 0.01）. Set and Serum uric acid significantly decreased. Creatinine clearance rate （Ccr） increased. Both of patient survival and graft survival are 1 00%. . Common adverse event is hyperlipidemia. Conclusions： Conversion from CNI- based to sirolimus based therapy is safe and effective in renal transplantation recipients with hyperbilirubinemia.