肾移植急性排斥后环孢素切换成他克莫司对移植肾的影响

Effect of switch from cyclosporine to FK506 on renal graft outcome in patients after initial acute rejection

目的探讨。肾移植术后急性排斥发生后环孢素（CsA）切换成他克莫司（FK506）抗排斥治疗对移植肾的影响。方法回顾性分析本中心肾移植患者发生病理证实的急性排斥86例，经过抗排斥治疗后有23例由CsA治疗切换成FK506为基础的免疫抑制治疗（FK506组），63例继续应用CsA为基础的免疫抑制治疗（CsA组）。比较两组临床资料，包括性别、年龄、冷和热缺血时间、淋巴毒、术前群体反应性抗体（PRA）水平、人类白细胞抗原（HLA）错配、血脂、血清肌酐、血尿酸、再次排斥的发生率和移植肾存活等情况。结果抗排斥治疗后1年内再次病理证实的排斥率，FK506组显著低于CsA组[1／23（4．35％）比16／63（25．40％），P=0．0331。FK506组急性排斥发生后5年内的移植肾存活率为100％，高于CsA组的81．4％。FK506组急性排斥发生后24个月及36个月血尿酸分别为（265．5±147．9）μmol／L和（245．8±88．9）μmol／L，均显著低于CsA组的（428．5±119．3）μmol／L和（441．2±125．3）μmol／L（P〈0．01）。结论肾移植术后急性排斥发生后由CsA治疗切换成FK506治疗可降低再次排斥的发生率，而降低血尿酸水平有利移植肾的存活。

Objective To investigate the effect of swifch from cyclosporine to FK506 on renal allograft outcome after initial acute rejection. Methods Clinical outcome of patients who experienced first acute rejection episode were retrospectively analyzed. After initial acute rejection, 23 patients were switched to FK506-based immunosuppression, and 63 patients continued CsA-based immunosuppression. Demographic data, lipid, serum creatinine, uric acid, incidence of recurrent acute rejection and graft survival were analyzed and compared. Results During one year after anti-rejection therapy, incidence of biopsy-proved recurrent rejection events was significantly lower with FK506 therapy （1/23, 4.35%） compared with CsA therapy （16/63, 25.40%） （P=0.033）. 5-year graft survival rate of FK506-based immunosuppression group was higher than that of CsA-based immunosuppression group （100.0% vs 81.4%）. Serum uric acid level of FK506- based immunosuppression group from 24 months to 36 months after initial rejection were significantly lower than that of CsA-based immunosuppression group [（265.5±147.9）μmol/L, （245.8±88.9）μmol/L vs （428.5±119.3）μmol/L, （441.2±125.3）μmol/L, P〈0.01, respectively]. Conclusion Conversion to FK506 therapy can significantly reduce recurrent rejection episode, and decreasing serum uric acid level provides long-term benefits to graft survival.