多器官联合移植的免疫抑制治疗

Immunosuppressive therapy after multiple organ transplantation

目的 探讨多器官联合移植术后的免疫抑制治疗方法。方法 对 2例 1型糖尿病并发尿毒症患者施行改良式胰液肠腔引流式胰、十二指肠及肾一期联合移植 ;1例高龄酒精性肝硬化终末期并发慢性肾功能不全尿毒症患者和 1例肝硬化肝功能衰竭肝移植术后移植肝、肾功能衰竭患者施行一期肝肾联合移植 ;1例慢性乙型病毒性肝炎、肝硬化、原发性肝细胞肝癌合并胰岛素依赖型糖尿病患者施行同期原位肝 -异位胰十二指肠联合移植术。术后采用抗胸腺淋巴细胞球蛋白 (ATG)、抗CD2 5单克隆抗体诱导 ,他克莫司 (FK5 0 6 )、霉酚酸酯 (MMF)及激素三联维持治疗。结果 5例患者术后移植物功能恢复良好 ,其中 1例胰肾联合移植患者术后出现 1次FK5 0 6导致的肾中毒 ,1例肝肾联合移植患者和肝胰联合移植患者术后发生 1次急性排斥反应 ,分别经调整药物剂量和抗排斥治疗后逆转。目前 5例患者全部存活 ,移植物功能正常。结论 多器官联合移植术后采用ATG、抗CD2 5单克隆抗体诱导 ,FK5 0 6、MMF及激素三联维持治疗是安全有效的 ,用药期间应监测移植物功能和FK5 0 6的血药浓度 ,防止排斥反应和FK5 0 6中毒。

Objective To study immunosuppressive therapy after multiple organ transplantation. Methods Simultaneous kidney-pancreas transplantation(SKPT) with enteric drainage of pancreatic exocrine secretions was performed in 2 patients with type 1 diabetes and end-stage renal disease. Combined liver-kidney transplantation(CLKT) was performed in a 66-year-old patient with alcoholic liver cirrhosis and uremia and in a patient with liver and renal failure after liver transplantation. Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation(SLPT) was performed in a patient with hepatitis B, hepatocirrhosis, hepatic cellular cancer and type 1 diabetes. All patients received immunosuppressive triple therapy includes tacrolimus(FK506), mycophenolate mofetil(MMF) and steroids after induction therapy with antithymocyte globulin(ATG) and anti-CD25 monoclonal antibody. Results All patients achieved good graft functional recovery. One of the SKPT patients experienced nephrotoxicity of FK506. One acute rejection occurred in the CLKT and SLPT patients, both reversed by adjusting the dose of FK506 and anti-rejection therapy. At present, all patients survive with a normal graft function. Conclusion Induction therapy with ATG and anti-CD25 monoclonal antibody and maintaining therapy including FK506, MMF and steroids after multiple organ transplantation are safe and effective. Monitoring of graft function and FK506 level is important for avoiding the rejection and nephrotoxicity caused by FK506.