他克莫司治疗肾移植术后耐激素性排斥反应的临床观察

Clinical effect of FK506 on the treatment of steroid-resistant rejection after kidney transplantation

目的 观察用他克莫司 (FK5 0 6 )替换环孢素A(CsA)治疗肾移植术后耐激素性排斥反应的效果。方法 2 6例肾移植患者应用CsA后出现排斥反应 ,经用甲泼尼龙 (MP) 0 .5g/d× 3d冲击治疗效果不佳 ,改用FK5 0 6治疗 ,FK5 0 6的浓度维持在 8～ 12 μg/L左右 ,临床症状减轻 ,免疫及生化指标逐渐好转 ,为治疗有效。治疗无效者主要改用单克隆抗CD3抗体 (OKT3)治疗。结果 本组 2 6例耐激素性排斥经改用FK5 0 6后 ,2 3例分别在 8～ 15d逆转 ,肾功能恢复正常 ,治愈率 88.46 % (2 3/2 6 )。 3例治疗效果不佳 ,使用血浆置换治疗和OKT35mg/d× 5d后排斥逆转。 2 6例肾功能全部恢复正常 ,但有 3例出现高血糖。结论 FK5 0 6治疗耐激素性排斥反应效果好 ,副作用小。治疗时应掌握诊断标准 ,注意监测血糖及生化指标。对于PRA高于 30 %的患者行血浆置换治疗 ,加用OKT3冲击治疗 ,可取得满意的效果。经上述治疗效果不佳者应及早切除移植肾 。

ObjectiveTo evaluate the efficacy and safety of conversion from cyclosporine (CsA) to FK506 in the treatment of steroid resistant rejection in renal transplant recipients. Methods Twenty six patients with acute rejection after kidney transplantation were not recovered by the treatment with MP. All of them received the treatment of FK506 substituting for CsA, and the results of conversion were assessed by allograft function and clinical outcome. Dose of FK506 was subsequently adjusted to maintain its whole blood trough levels between 8～12?μg/L. Results After the use of FK506, steroid resistant rejection was reversed in 23 cases ( 88.46%) within 8～15 days and the remaining 3 patients not recovered were cured by the adoption of plasma exchange and the application of OKT3. The renal function were recovered in all of the patients, but hyperglycosemia occurred in 3 cases. Conclusions It is effective and safe to substitute CsA by FK506 in the treatment of steroid resistant rejection in renal transplantation patients. Satisfactory result would be usually achieved with the adoption of plasma exchange and the application of OKT3 in the recipient with hypersensitivity to PRA. Resection of the renal allograft should be carried out if the renal function kept unnormal after these treatments.