免疫抑制剂在肝移植术后特殊状态下的应用分析

Application of Immunosuppressants under Specific Conditions after Liver Transplantation

目的探讨肝移植术后免疫抑制剂个体化应用的方法.方法在经肝移植治疗后的患者中筛选出在不同情况下应用免疫抑制剂后的137例患者临床资料进行回顾性分析.结果 137例患者1 a生存率为82.5%(113/137),99例术后感染患者经减药或停药后87例存活;39例移植肝排斥患者(急排21例,慢排4例)在加药及激素冲击治疗后23例存活;再次手术的24例患者根据具体情况调整免疫抑制剂用量后,18例安全度过围术期;A,B,O血型不符肝移植3例,加用塞尼派及调高免疫抑制剂浓度后,2例预后良好;严重感染并急性排斥6例患者经降低免疫抑制剂浓度控制感染后再加强免疫抑制效果,4例存活.结论免疫抑制剂个体化用药是提高肝移植成功率和移植后生存质量的重要保证.

Objective To discuss the application of immunosuppressants under specific conditions after liver transplantation. Method The clinical data of 137 patients treated with immunosuppressants after liver transplantation were analyzed retrospectively. Results One-year survival rate of 137 patients was 82. 5% （113/137）,87 cases of 99 cases with postoperative infection survived after reducing the dosage or withdrawing immunosuppressants,and 23 of 39 cases with rejection after liver transplantation （21 cases of acute rejection and 4 cases of chronic rejection） survived by increasing the dosage and with the corticosteroid therapy. 18 of 24 cases treated with the second operation lived through the perioperative period by adjusting the dosage of immunosuppressants according to the specific circumstances,2 of 3 cases with incompatible A, B, O blood type survived by using zenapax and increasing the dosage of immunosuppressants, and 4 of 6 cases with serious infection complicated with acute rejection survived by lowering the dosage of immunosuppressants and enhancing the immunosuppressant therapy. Conclusion The individualized medication of immunosuppressants can play an important role in improving the survival rate of liver transplantation and the quality of life of patients after liver transplantation.