肾移植术后应用普乐可复(FK506)逆转环孢素A(CsA)引起肝功能损害的临床研究

Clinical study on the reversional effect of FK506 in renal allograft recipients with hepatic dysfunction resulted from CsA

目的 :观察普乐可复 (FK5 0 6 )替换环孢素A(CsA)在防治尸肾移植术后药物性肝损害的有效性和安全性。方法 :选择 2 5例尸肾移植术后应用CsA出现肝功能异常而肾功能正常患者 (移植术后 2个月～ 36个月 ,年龄 2 3岁～ 5 8岁 ) ,以FK5 0 6切换CsA ,FK5 0 6初始剂量及维持剂量以患者体重、移植后时间、病情及全血FK5 0 6血药浓度进行相应调整 ,同时予以保肝治疗。结果 :将CsA切换成FK5 0 6治疗 2周～ 4周后 ,患者肝功能指标 (血清ALT、D BIL及I BIL)呈明显下降趋势。 8周～ 10周后 ,19例患者肝功能恢复正常 ,6例接近正常 ,换药前后比较差异有显著性 ,P <0 0 5。肾功能 (血清Cr、BUN)换药前后比较差异无显著性 ,P >0 0 5。以上病例继续随访 3个月～ 6个月 ,肝功能、肾功能全部维持正常。结论 :对CsA引起肝功能损害的尸肾移植患者应用FK5 0 6替换治疗是安全有效的。

Objective To evaluate the therapeutic efficacy and safety of CsA in substitution for tacrolimus (FK506) in cadavcric kidncy transplant recipients with hepatic dysfunction resulted from CsA.Method 25 postoperative patients with hepatic dysfunction and normal renal function received the treatment of FK506 substituting for CsA.The initial and maintained dose of FK506 was based on body weight,the period after operation,the patient's condition and its wholeblood trough levels of FK506 of the patients.Therapy for protecting liver was administrated during this period.Results Substitute of tacrolimus for cyclosporin resulted in a markedly reduced blood indices(ALT,D BIL and I BIL) from 2 to 4 weeks.In 8 to 10 weeks,liver function of 19 cases returned normal,and this differences between before and after conversion were significant ( P <0.05).The differences in renal function (serum Cr and BUN) between before and after conversion were not significant ( P >0.05).In the follow up study,it was found that the liver and renal function in all the patients returned normal.Conclusion It is effective and safe to substitute CsA by FK506 in cadaceric kidney transplant recipients with hepatic dysfunction resulted from CsA.