CAJ | 학술논문

目的为了了解肝移植术后,基于钙调磷酸酶抑制剂(CNI)减量的吗替麦考酚酯(MMF)免疫抑制方案改善肝移植术后肾损害的临床效果.方法我们回顾分析3年内资料完整的124例肝移受体术后CNI相关肾损害发生情况,总结基于CNI减量的MMF免疫抑制方案改善肝移植术后肾损害的临床效果.结果 124例肝移植受体中,有14例(11.29%)发生CNI相关肾损害,其中5例(5/22)发生于环孢素A(CsA)组,9例(9/102)发生于他克莫司(TAC)组,术后发生肾损害的时间为(12.92±9.04)个月(1～31个月).TAC剂量降低约55%[(2.6±1.14)mg/d与(1.1±0.22)mg/d;t=3.000,P=0.040],CsA剂量降低约70%(370±179)mg/d与(105±27);t=3.359,P=0.028,MMF平均剂量为(1.05±0.15)g/d(0.5～1.5 g/d).免疫抑制方案调整后平均随访时间(6.00±3.37)个月(3～14个月),14例肾损害受体血清肌酐从(139±46)μmol/L降到第1、2、3个月的(122±46)μmol/L(t=3.152,P=0.004)、(114±53)μmol/L(t=4.180,P=0.001)和(93±18)μmol/L(t=4.721,P=0.000);肌酐清除率从(52±21)ml/min增加到第1、2、3个月的(63±22)ml/min(t=-3.439,P=0.004)、(69±25)ml/min(t=-4.207,P=0.001)和(79±25)ml/min(t=-6.149,P=0.000).71.43%(10/14)CNI相关肾损害受体血清肌酐水平恢复正常,21.43%(3/14)血清肌酐水平显著降低,7.14%(1/14)死于肾功能衰竭.结论基于CNI减量的MMF免疫抑制方案能持续显著改善肝移植术后CNI相关肾损害,并具有良好的安全性和耐受性.
목적 위료료해간이식술후,기우개조린산매억제제(CNI)감량적마체맥고분지(MMF)면역억제방안개선간이식술후신손해적림상효과.방법 아문회고분석3년내자료완정적124례간이수체술후CNI상관신손해발생정황,총결기우CNI감량적MMF면역억제방안개선간이식술후신손해적림상효과.결과 124례간이식수체중,유14례(11.29%)발생CNI상관신손해,기중5례(5/22)발생우배포소A(CsA)조,9례(9/102)발생우타극막사(TAC)조,술후발생신손해적시간위(12.92±9.04)개월(1～31개월).TAC제량강저약55%[(2.6±1.14)mg/d여(1.1±0.22)mg/d;t=3.000,P=0.040],CsA제량강저약70%(370±179)mg/d여(105±27);t=3.359,P=0.028,MMF평균제량위(1.05±0.15)g/d(0.5～1.5 g/d).면역억제방안조정후평균수방시간(6.00±3.37)개월(3～14개월),14례신손해수체혈청기항종(139±46)μmol/L강도제1、2、3개월적(122±46)μmol/L(t=3.152,P=0.004)、(114±53)μmol/L(t=4.180,P=0.001)화(93±18)μmol/L(t=4.721,P=0.000);기항청제솔종(52±21)ml/min증가도제1、2、3개월적(63±22)ml/min(t=-3.439,P=0.004)、(69±25)ml/min(t=-4.207,P=0.001)화(79±25)ml/min(t=-6.149,P=0.000).71.43%(10/14)CNI상관신손해수체혈청기항수평회복정상,21.43%(3/14)혈청기항수평현저강저,7.14%(1/14)사우신공능쇠갈.결론 기우CNI감량적MMF면역억제방안능지속현저개선간이식술후CNI상관신손해,병구유량호적안전성화내수성.
Objective Renal dysfunction caused by calcineurin inhibitor (CNI) after liver transplantation is a major complication among the long-term surviving recipients. Several studies have demonstrated that the adverse events could be prevented or avoided by mycophenolate mofetil (MMF) -based CNI reduced immunosuppressive protocol. In this retrospective study, we analyzed the middle-term effect of this regimen upon improving the CNI-associated renal dysfunction. Methods 124 OLT recipients' data within the recent three years were reviewed in this study. Results Renal dysfunction developed in 14 cases and its incidence was 11.29%. Five cases of them were from eyclosporine A (CsA) group and 9 from tacrolimus (TAC) group. The postoperative time ranged from 3-39 months with a mean follow-up duration of 19.26±9.30 months. The interval between renal impairment and surgery was 12.92±9.04 (1-31) months. CNI were reduced stepwise by about 55% in TAC group (TAC 2.60±1.14 mg/d vs 1.10±0.22 mg/d; t=3. 000, P=0.040) and about 70% in CsA group (CsA 370±179 mg/d vs 105±27; t=3.359, P=0.028). Serum creatinine had decreased from 139±46 μmol/L to 122±46 μmol/L (t=3.152, P= 0.004), 114±53 μmol/L (t=4.180, P=0.001) and 93±18 μmol/L (t=4.721, P=0.000) after administrating a mean MMF dose of 1.05±0.15 g/d (0.5-1.5 g/d) for 1,2 and 3 months respectively. And the creatinine clearance rate increased from 51.83±21.28 mL/min to 63±22 ml/min (t=-3.439, P=0.004), 69±25 ml/min (t=-4.207, P=0.001) and 79±25 ml/min (t=-6.149, P=0.000) during the corresponding period. Improvement was maintained within a follow-up period of 6.00±3.37 (3-14) months without major immunological or non-immunological side effects, except for 1 recipient from another institution who died of CNI-associated renal failure within 1 month after burst. 71.43% (10/14) of recipients achieved the normalization of serum creatinine and 21.43% (3/14) experienced a significant reduction in their serum creatinine levels. Conclusions MMF-based CNI reduced immunosuppressive protocol can improve substantially CNI-associated renal dysfunction after liver transplantation. And the long-term surviving recipients have excellent profiles of safety and tolerance.