肾移植术后不同阶段他克莫司缓释剂型转换的回顾研究

A retrospective analysis of the effect of tacrolimus conversion in different periods post-renal transplantation

目的回顾分析肾移植术后不同时期,肾移植受者免疫抑制剂方案由他克莫司转化为他克莫司缓释胶囊的临床特点,为临床肾移植术后免疫抑制剂的治疗给药提供参考。方法根据药物转化的时间,将156例肾移植受者分为三组,比较不同组别换药前后肝肾功能血糖血脂及术后相关指标的影响。结果三组新发糖尿病比例的差异有统计学意义(P=0.025)。免疫诱导方案三组间的差别无统计学意义,免疫抑制剂维持方案三组比较中霉酚酸酯(G3组占68.8%)为主转化为霉酚酸(G1组占72%)为主,差异有统计学意义(P<0.001)。他克莫司用量,三组受者日平均用量(P<0.001)和单位体重的平均用量(P<0.001)差异均有统计学意义。随着术后时间的延长他克莫司平均血药浓度谷值差异有统计学意义(P<0.001)。三组换药的方法差别无统计学意义;G1和G2组换药前后谷值差异有统计学意义。结论肾移植术后不同时期均可选择他克莫司转换他克司缓释剂型的方案,药物剂型的转化降低了佐剂用量,血药浓度及肌酐水平更为稳定,为更优化的免疫抑制方案。

Objective To summarize the clinical characteristics of recipients of renal transplantation who used tacrolimus extended-release capsules, to optimize the postoperative immunosuppressive regimen, and provide reference for the therapeutic administration of immunosuppressive agents after renal transplantation. Methods156 patients who had renal transplant in our center were divided into three groups according to the time of the change of the extended-release tacrolimus capsules, and the blood glucose and blood lipids of each group were analyzed. ResultsThe longer the postoperative duration was, the higher proportion of new-onset diabetes cases (P=0.025). There was no significant difference among the three groups of immune induction regimens. The immunosuppressive regimen was changed from MMF (68.8% in G3 group) to MPA (72% in G1 group). With the prolongation of postoperative time, the dosage of tacrolimus decreased gradually. The mean tacrolimus concentration in the 3 groups was significantly different (P<0.001) as time went by. There was no significant change in the average daily dosage before and after the change. The trough value before and after the change in the first two groups was significantly different (P<0.001). ConclusionThe extended-release tacrolimus capsules could be used in different stages after renal transplantation. After the conversion of the extended-release tacrolimus capsules, the dosage of adjuvant is reduced, and blood concentration and creatinine level are more stablem which is a more optimized immunosuppressive regimen.