肝移植2例的免疫抑制疗法

Immunosuppressive therapy for 2 patients with liver transplantation

目的 探讨肝移植术后的免疫抑制疗法 .方法 国内首例活体肝移植和首例辅助性活体肝移植患者分别采用环孢素 A和 FK5 0 6作为主要免疫抑制剂成功实施了两类术式的免疫调控 .结果 例 1供受体为父女关系 ,术后采用环孢素 A联合硫唑嘌呤、皮质激素行免疫抑制治疗 ,术后 3mo停用硫唑嘌呤、5 mo停用激素改用酶酚酸酯 ,手术 1a后环孢素A血药浓度控制在 5 0～ 10 0μg· L- 1 ,患者已健康生存 4 1mo;例 2供受体血型不同 ,供体为 A型血、受体为 O型血 ,围手术期采用环磷酰胺、FK5 0 6、皮质激素联合免疫抑制治疗 ,手术前 8d开始使用环磷酰胺 ,术后 1mo停用 ,术后 5 mo停用皮质激素改用酶酚酸酯 ,现 FK5 0 6血药浓度维持在 10～ 15μg·L- 1 ,目前患者已健康生存 6 m o.结论 肝移植术后需要据患者的具体情况采用个体化的免疫抑制疗法 ,无论环孢素A还是 FK5 0 6均有较好的疗效 ,术后 0 .5

AIM To explore the immunosuppressive therapy for post liver transplantation. METHODS Clinical therapyfor the patients who were the first domestic case of living related liver transplants and the first case of auxiliary living related transplants was reviewed, using cyclosporine A and FK506 as the major immunosuppressive agents to control immunity states respectively. RESULTS Case one: The recipient was a 9 year old girl and the donor was her father. After the transplantation, 3 adjutant immunosuppressive therapy (cyclosporine A, azotiopine, glucocorticoid) was used. Azathioprine and glucocorticoid were stopped 3 and 5 months later respectively. And glucocorticoid was replaced by mycophenolate mofetil. One year later, CsA blood level was maintained between 50 and 100 μg·L -1 . The patient has been surviving for 3.5 years. Case two: The donor and recipient's ABO blood group was mismatched, type A and type O respectively. In perioperation period, we used cytoxan,FK506 and glucocorticoid. 8 days before the operation cytoxan was administrated and stopped after one month's, freatment and also glucocorticoid was replaced by mycophenolate mofetil 5 months after the operation, now FK506 blood level is maintained 10~15 μg·L -1 , the patient has been surviving for 6 months. CONCLUSION Immunosuppressive therapy for post liver transplantation should be used individually according to the patients physical condititions. Either CsA or FK506 is quite effective. It is safe to stop using glucocorticoid within half a year of post operation.