西罗莫司在肝移植术后免疫抑制中的效果及安全性

The efficacy and safety of sirolimus in immunosuppression after liver transplantation

目的探讨肝移植术后应用西罗莫司（SRL）的免疫抑制效果和安全性。方法对21例以SRL作为免疫抑制维持治疗的肝移植受者进行了观察。其中术后直接应用SRI。者6例（术前肾功能不全者2例、原发病为肿瘤者4例）；因他克莫司（Tac）药物相关性因素替换为SRL者15例（Tac肾毒性4例、高度可疑Tac肝毒性8例、Tac用量过大仍不能达到预期血药浓度者3例）。术后对21例受者平均随访25．4个月（6-42个月），评估SRL的临床免疫抑制效果及安全性。结果随访期间，2例受者因药物副反应停药，药物耐受率为90．5％。发生急性排斥反应1例次，经治疗后痊愈，其余患者均获得良好的免疫抑制效果。Tac肾毒性患者肾功能改善3例；Tac肝毒性患者肝功能显著好转6例。结论SRL作为受者肝移植术后的免疫抑制维持治疗是安全有效的。术后早期及时用SRL替换Tac可有效逆转后者所致的肝、肾毒性损害。

Objective To evaluate the efficacy and safety of Sirolimus （SRL） in immunosuppression following liver transplantation. Methods SRL was applied in 21 patients totally. Indication for adoption was Tac-related nephrotoxicity （4/21）, suspiciously Tac-related hepatoxicity （8/21）, Tac overdose （3/21）, renal insufficiency preoperation （2/21）, or cancer （4/21）. Median follow-up was 25.4 months. Results SRL provided an adequate prophylaxis against rejection in all study patients, with one case of acute rejection. Sirolimus was Withdrawn in 2 cases due to its side- effect. Tac-induced hepatoxicity in 6 cases and nephrotoxicity in 3 cases were relieved significantly. Conclusions SRL given alone appears to be an effective primary immunosuppressant regimen for orthotopic liver transplantation patients. Early conversion contributes to significant improvement of Tac-related hepatoxicity and nephrotoxicity.