摘要
目的总结小儿活体供肝移植术后应用以他克莫司（Tac）或环孢素A（CsA）为基础免疫抑制方案的体会。方法回顾性分析2006年10月至2010年1月进行小儿活体肝移植的30例受者术后免疫抑制剂的用量、血药浓度、药物不良反应等临床资料。其中，7例以Tac为主要免疫抑制剂（Tac组），10例以CsA为主要免疫抑制剂（CsA组）；其余13例因发生并发症或药物不良反应将CsA转换为Tac。记录术后免疫抑制剂的用量及其血药浓度谷值，监测肝肾功能指标的变化，观察排斥反应、感染等并发症的发生情况及药物不良反应。结果在维持血药浓度及肝肾功能稳定的前提下，术后1年受者体重可增加约50％，但免疫抑制剂的单位体重用量可明显减少。Tac组均未发生排斥反应，CsA组发生排斥反应4例（40％，4／10），均经增加免疫抑制剂用量后逆转。术后3个月内，Tac组出现腹腔感染1例（1／7），CsA组出现肺部感染3例（3／10），经抗感染治疗后均好转。Tac组出现巨细胞病毒IgM阳性1例（1／7），CsA组出现2例（2／10），使用更昔洛韦抗病毒治疗后均好转。两组在术后3个月后均未出现新发感染及移植后淋巴组织增生性疾病。13例转换用药的受者在转换用药后并发症和药物不良反应逆转。结论小儿活体肝移植术后Tac和CsA均可安全应用，二者促进肝肾功能恢复的效果相似，但Tac抑制排斥反应的效果较好，并且药物不良反应也相对较少。
Objective To summarize the experience of tacrolimus or cyclosporine A-based after pediatric living-donor liver transplantation. Methods The clinical data of 30 children undergoing living-donor liver transplantation from October 2006 to January 2010 were analyzed retrospectively. In 30 patients, 7 were given Tac-hased （group B）, and 13 switched from CsA to mppression （group A）, 10 given CsA-hased Tac for complications or adverse effects of drugs. Dosages and blood concentrations of immunosuppressants were recorded. Changes of liver and kidney functions were monitored. Incidence of rejection, infection and adverse effects of drugs were observed. Results In the premise of the stable concentration and liver and kidney functions, the weight of children was increased by about 50% and the perkilogram dosage of CNIs was decreased significantly 1 year postoperatively. There was no ease of rejection in group A and 4 cases of rejection in group B（40%, 4/10）, and the original symptoms were gradually alleviated after the increased dosage in immunosuppressants. During the first 3 months, there was 1 case of abdominal infection in group A （1/7） and 3 cases of lung infection in group B （3/10）, and the original symptoms were gradually alleviated after anti-infective therapy. There was 1 CMV IgM-positive case in group A （1/7） and 2 CMV IgM-positive cases in group B （2/10）, and the original symptoms were gradually alleviated after using ganciclovir. The original symptoms of the 13 children switched from CsA to Tac were gradually alleviated. Caaelusion The two CNIs can be safely used in children undergoing pediatric living-donor liver transplantation. Both of them show the same effect in promoting the restoration of liver and kidney functions, but tacrolimus has more satisfactory effect in inhibiting the rejection and it has less adverse effects.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2012年第5期283-286,共4页
Chinese Journal of Organ Transplantation
关键词
肝移植
儿童
学龄前
活体供者
他克莫司
环孢菌素
Liver transplantation
Child, preschool
Living donors
Tacrolimus
Cyclosporine
