肾移植术后肝功能异常患者用他克莫司替换环孢素A疗效的初步观察

Therapeutic effects of tacrolimus substituting for cyclosporin in renal transplant recipients with hepatic dysfunction

目的 观察他克莫司 (FK5 0 6 )替换环孢素A(CsA)并联合应用霉酚酸酯 (MMF)及泼尼松 (Pred)防治肾移植术后肝功能异常患者的有效性及安全性。方法 肾移植术后 8例肝功能异常患者 (男性 5例 ,女性 3例 ,平均 38.2 3岁 ) ,用FK5 0 6替换CsA治疗 ,停用CsA 2 4h后 ,开始给予FK5 0 6。FK5 0 6初始剂量根据患者体重、肝功能损害程度及术后时间确定 ,服药 1周后 ,根据全血FK5 0 6谷值浓度调整剂量 ,使其谷值浓度维持于 5～ 15 μg/L。结果 用FK5 0 6替换CsA ,1个月后患者血中直接胆红素从替换前的 (2 2 .6 6± 17.19) μmol/L下降至 (7.0 5± 2 .32 ) μmol/L ,P <0 .0 5 ;间接胆红素从替换前的 (4 2 .15± 34.15 ) μmol/L下降至 (14.5 4± 2 .5 9) μmol/L ,P <0 .0 5 ;血清丙氨酸转氨酶从替换前的 (83 .0 0± 93 .14)IU/L下降至 1个月后的 (2 9.5 0± 15 .41)IU/L ,P >0 .0 5 ;血清肌酐从 (177.91±86 .41) μmol/L下降至 (135 .92± 34.0 5 ) μmol/L ,P >0 .0 5。 3例腹水的患者均于药物替换 1个月后完全消失。仅有 1例患者出现便秘、食欲下降伴上肢颤抖。结论 用FK5 0

Objective To evaluate the efficacy and safety of CsA substituted by tacrolimus (FK506) combined with MMF and prednisone in prevention of rejection in renal transplant recipents with hepatic dysfunction. Methods Eight patients with hepatic dysfunction received the treatment of FK506 substituting for CsA. FK506 was administeted at least 24?h after the last dose of cyclosporine. The initial dose of FK506 was based on body weight, the degree of hepatic dysfunction and the period after operation of the patients. After administration of one week, the dose of FK506 was subsequently adjusted to maintain its whole blood trough levels between 5～15?μg/L. Results Substitute of tacrolimus for cyclosporin resulted in a markedly reduced blood index, direct bilirubin from( 22.66 ± 17.19 )μmol/L to ( 7.05 ± 2.32 )μmol/L ( P < 0.05 ), indirect bilirubin from ( 42.15 ± 34.15 )μmol/L to ( 14.54 ± 2.59 )μmol/L ( P < 0.05 ), sALT from ( 83.00 ± 93.14 )IU/L to ( 29.50 ± 15.41 ) IU/L ( P > 0.05) , Cr from ( 177.91 ± 86.41 )μmol/L to ( 135.92 ± 34.05 )μmol/L ( P > 0.05 ) in one month. The ascites of 3 patients disappeared in one month. Astriction, anorexia, upper limbs trembling appeared only in one patient. Conclusion It is effective and safe to substitute CsA by FK506 combined with MMF and prednisone in prevention of rejection in renal transplant recipients with hepatic dysfunction.