肝移植术后长期存活慢性肾功能损害受者的免疫抑制方案个体化应用

Individualized immunosuppressive regimens for long-term surviving liver transplant recipients with chronic renal dysfunction

目的探讨肝移植术后长期存活慢性肾功能损害受者应用个体化免疫抑制方案的疗效。方法选择18岁以上、肝移植术后2年以上、入组前采用以他克莫司(FK506)为基础免疫抑制方案、肝功能正常而肾功能损害的受者,共32例。根据免疫功能评分和白细胞计数制定个体化免疫抑制方案,以FK06用量最小化为原则,转换为麦考酚吗乙酯(MMF)或西罗莫司,并调整其用量。调整后至少每个月随访1次,进行肝功能、肾功能、血常规检查和免疫功能评估。结果 32例受者经个体化免疫抑制方案治疗,随访(24.3±7.6)个月,个体化治疗后各时段的肾小球滤过率(GFR)均较此前有明显提高(均为P<0.01),以调整用药后1个月最明显。无发生排斥反应。结论根据免疫功能评分和白细胞计数制定个体化免疫方案,使FK506用量最小化,可以有效改善肝移植术后长期存活的受者的肾功能,并不增加排斥反应的发生率。

Objective To evaluate the effect of individualized immunosuppression regimens on chronic renal dysfunction in long-term surviving liver transplant recipients.Methods Thirty-two recipients over 18 years old were entered into the study,who underwent liver transplantation over 2 years.These recipients with normal liver function but impaired renal function,received tacrolimus（FK506） based immunosuppression regimen before study entry.Immunosuppression regimens were tailored according to the immune function and white blood cell（WBC） count,by reducing the dose of FK506 and conversion to mycophenolate mofetil（MMF） or sirolimus based immunosuppression protocol.After adjustmment for at least 1 time per month,hepatic function,renal function,blood routine examination and assessment of immune function were measured.Results After individualized immunosuppression regimens treatment,these patients were followed up for（24.3±7.6） months.Glomerular filtration rate was significantly elevated after treatment（all in P0.01）,which was most significant at 1 month after regimen adjustment.No rejection occurred during follow-up.Conclusions Indivi-dualized FK506-sparing immunosuppression regimens guided according to the immune function and WBC count can ameliorate renal dysfunction in long-term surviving liver transplant patients,but not increase the risk of rejection.