摘要
目的:前瞻性观察他克莫司(FK506)联合霉酚酸酯(MMF)作为肾移植术后急性体液性排斥(AHR)的挽救治疗的有效性,为中国肾移植受者AHR的救治寻找一个可行的方案。方法:160例肾移植受者,根据临床表现、组织学特征、移植肾组织C4d染色符合AHR诊断标准者11例,所有患者在排斥发生时均立即应用FK506联合MMF治疗,除激素冲击外,所有患者均不接受免疫吸附、血浆置换等其他治疗方案,需要透析的患者给予连续性血液净化(CBP)治疗。结果:11例符合AHR的诊断,均表现为急剧的移植肾功能下降,治疗上无一例对冲击治疗有反应,所有患者移植肾组织肾小管周围毛细血管(PTC)部位均有弥漫的C4d沉积,接受FK506联合MMF治疗初期,所有患者仍表现为移植肾功能的进行性减退,其中10例接受了CBP治疗,在治疗4～26(16.19±6.16)天后,11例患者均出现尿量增多,移植肾功能逐渐恢复正常,平均随访12.8个月,移植肾功能均保持稳定。结论:在中国人中,FK506联合MMF能够有效逆转肾移植术后早期发生的难治性AHR,并且副作用少,经济安全,是适合中国人特点的一种治疗方案。
Objective：To investigate the efficiency of tacrolimus and mycophenolate mofetil （MMF） as rescue therapy for early acute humoral rejection （AHR） after renal transplantation in renal allograft recipients. Methodology： One hundred and sixty renal allograft recipients were enrolled in this prospective study, among them 11 cases were diagnosed as having AHR during 2 weeks post transplantation. The diagnosis was based on clinical manifestations, histological changes and C4d staining. Once rejection episode occurred, pulse methylprednisone therapy was selected as the first-line treatment. At the same time, all the patients were subjected to tacrolimus/MMF rescue. Continuous veno-venous hemofiltration （CVVH） other than regular hemodialysis was performed when patients need dialysis. No other rescue methods such as ATG, immunoadsorption, PP et al were used in this group according to the study design. Results：Among the 11 patients, there were 9 middle age females and two males, no recipients had response to pulse methylprednisolone treatment, and 10 received CBP. After （16. 19±6.16） days of treatment, all rejection episodes were successfully reversed, and the graft function were stable during the follow-up. Conclusion：Our data suggests that FK506 combined with MMF alone can effectively reverse almost early AHR after renal transplantation in renal allograft recipients.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2006年第1期12-17,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
罗氏移植科研基金资助
关键词
肾移植
急性排斥
CAd
他克莫司
霉酚酸酯
renal transplantation
acute rejection
C4d
tacrolimus
mycophenolate mofetil
作者简介
通讯作者,黎磊石（E-mail：lilsh@cae．cn）
