肾移植患者肝功能受损治疗方案的选择

Therapeutic Options for Kidney Transplantation Recipients with Liver Injury

目的:评估肾移植术后肝功能损害时治疗方法的选择。方法:回顾分析43例肾移植术后发生肝功能损害患者的临床资料,按照抗病毒药物(a)、护肝药物(b)以及调整免疫抑制剂(c)单独或联合治疗分组,监测肝肾功能、总治疗时间、排斥反应、感染发生。结果:随访6-36月,药物性肝损害或乙型肝炎(HBV)所致肝损害中经2种或3种治疗措施联用较1种或2种治疗1周后的丙氨酸氨基转移酶(ALT)下降明显(P<0.05),且可以明显缩短总体治疗时间(P<0.05)。肝损害治疗期间2例发生排斥反应,无肝功能衰竭、感染发生。结论:肾移植术后肝功能损害患者治疗上应联合采用抗病毒治疗、护肝治疗、调整免疫抑制剂用药方案。

Objective： To evaluate the therapy choice for liver injury caused by immunosuppressant therapy after kidney transplantation for recipients.Methods： Forty-three cases were involved in this study because of liver function abnormality after kidney transplantation.Three therapeutic ways as anti-HBV drugs（a）,hepatic protective drugs（b）,and/or adjustments of immunosuppressant protocol（c） were adopted.Liver function,kidney function,treatment time,rejection,as well as infection were analyzed.Results： During a 6-36 months follow-up period,two or three kinds of combined therapies significantly decreased the ALT level in the first week and shortened treatment course.During the period of treating liver injury,2 cases appeared rejection,without liver failure and infection.Conclusion： The best therapeutic choice for kidney transplanted patients with liver injury should combine anti-HBV drug,hepatic protective drugs,and adjustment of the immunosuppressant protocol.