CAJ | 학술논문

背景:亲属活体肾移植供、受者移植前准备充分,供肾热、冷缺血时间较短,HLA 配型的组织相容性好,移植后排斥反应发生率低,为亲属活体供肾肾移植后采用低剂量免疫抑制剂方案提供了可能性.目的:探讨亲属活体供肾移植后低剂量钙调蛋白酶抑制剂的安全性和有效性.方法:选取2006-01/2008-06 在南京医科大学第一附属医院肾移植中心行亲属活体供肾移植的受者38 例,移植后常规使用环孢素A/他克莫司+吗替麦考酚酯+泼尼松的三联免疫抑制方案.将38 例患者随机分为两组:CNI 常规剂量组(n=18),移植后初始药物剂量为环孢素A 6 mg/(kg·d)或他克莫司0.12 mg/(kg·d);CNI 低剂量组(n=20),术后初始药物剂量为环孢素A 4 mg/(kg·d)或他克莫司0.08 mg/(kg·d);两组吗替麦考酚酯和泼尼松使用剂量相同.移植后密切随访,比较两组患者移植后不同时期的肾功能以及急性排斥反应、肺部感染、肝功能损害、肾毒性等并发症的发生情况.结果与结论:随访12 个月,CNI 常规剂量组重度肺部感染死亡1 例,CNI 低剂量组无死亡病例.两组移植肾功能及急性排斥反应发生率比较差异均无显著性意义(P ＞ 0.05);CNI 低剂量组肝功能损害、钙调蛋白酶抑制剂肾毒性发生率显著低于CNI 常规剂量组(P ＜ 0.05).此外,采用低剂量钙调蛋白酶抑制剂免疫抑制方案明显减轻了亲属肾移植患者的经济负担.说明亲属活体供肾移植后采用低剂量钙调蛋白酶抑制剂的免疫抑制剂方案安全、有效.
배경:친속활체신이식공、수자이식전준비충분,공신열、랭결혈시간교단,HLA 배형적조직상용성호,이식후배척반응발생솔저,위친속활체공신신이식후채용저제량면역억제제방안제공료가능성.목적:탐토친속활체공신이식후저제량개조단백매억제제적안전성화유효성.방법:선취2006-01/2008-06 재남경의과대학제일부속의원신이식중심행친속활체공신이식적수자38 례,이식후상규사용배포소A/타극막사+마체맥고분지+발니송적삼련면역억제방안.장38 례환자수궤분위량조:CNI 상규제량조(n=18),이식후초시약물제량위배포소A 6 mg/(kg·d)혹타극막사0.12 mg/(kg·d);CNI 저제량조(n=20),술후초시약물제량위배포소A 4 mg/(kg·d)혹타극막사0.08 mg/(kg·d);량조마체맥고분지화발니송사용제량상동.이식후밀절수방,비교량조환자이식후불동시기적신공능이급급성배척반응、폐부감염、간공능손해、신독성등병발증적발생정황.결과여결론:수방12 개월,CNI 상규제량조중도폐부감염사망1 례,CNI 저제량조무사망병례.량조이식신공능급급성배척반응발생솔비교차이균무현저성의의(P ＞ 0.05);CNI 저제량조간공능손해、개조단백매억제제신독성발생솔현저저우CNI 상규제량조(P ＜ 0.05).차외,채용저제량개조단백매억제제면역억제방안명현감경료친속신이식환자적경제부담.설명친속활체공신이식후채용저제량개조단백매억제제적면역억제제방안안전、유효.
BACKGROUND: Adequate preparation of donors and recipients prior to living-related donor renal transplantation, short warm and cold ischemia time for donor kidney, good histocompatibility of human leukocyte antigen match, and low postoperative rejection incidence provide feasibility for use of low-dose immunosuppressive agents after living-related donor renal transplantation. OBJECTIVE: To investigate the safety and effectiveness of low-dose calcineurin inhibitors (CNI), an immunosuppressive agent, in living-related donor renal transplantation. METHODS: A total of 38 recipients who underwent living-related donor renal transplantation at the Center of Renal Transplantation of the First Affiliated Hospital of Nanjing Medical University from January 2006 to June 2008 were randomized for treatment with mycophenolate mofetil (750 mg twice a day), prednisone, and either standard-dose CNI (n=18) or low-dose CNI (n=20) during 12 months post-transplantation. Ciclosporin A was given orally (starting dose, 6 and 4 mg/kg per day, respectively) in two divided doses to achieve the 12-hour whole blood concentration as measured by fluorescence polarization immunoassay. The starting dose of tacrolimus was 0.12 and 0.08 mg/kg per day respectively, and its whole blood concentration was measured by enzyme-multiplied immunoassay technique. After transplantation, patients were followed up. Renal function, pulmonary infection, liver dysfunction, and CNI nephrotoxicity at different time periods were compared between different regimens. RESULTS AND CONCLUSION: During 12 months post-transplantation, patient death occurred in one of 18 patients (5.6%) in the CNI standard-dose group and none of 20 patients (0%) in the CNI low-dose group. There was no significant difference in renal function and acute rejection between CNI standard-dose and CNI low-dose groups (P > 0.05). The incidence of liver dysfunction and CNI nephrotoxicity was significantly lower in the CNI low-dose group than in the CNI standard-dose group (P < 0.05). In addition, a low-dose CNI regimen helped recipients to lessen the economic burdens. These findings indicate that it is effective, safe and economical to use a low-dose CNI regimen in living-related donor renal transplantation.