活体部分供肝移植术后他克莫司的用量及代谢特点  

Metabolic characteristics and usage of tacrolimus in patients subject to living-donor partial liver transplantation

作　　者：汤晓寅[1] 夏强[1] 张建军[1] 李齐根[1] 徐宁[1] 陈小松[1] 王鑫[1] 韩龙志[1] 罗毅[1] 邢天宇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院移植科,200127

出　　处：《中华器官移植杂志》2010年第12期749-752,共4页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨和比较成人尸体全肝移植与活体部分供肝移植术后他克莫司（Tac）的用量、血药浓度和代谢特点.方法 回顾性分析2007年4月至2009年9月行肝移植的85例受者Tac的用量以及血药浓度等临床资料.其中,进行活体部分肝移植的受者34例（A组）,进行尸体全肝移植的受者51例（B组）.结果 肝移植术后,在使用相同的Tac初始剂量下,A组达到治疗窗的时间明显少于B组,A、B组分别为（3.4±1.0）d和（4.5±2.0）d,差异有统计学意义（P＜0.01）.A组Tac的用量在术后28 d内明显低于B组,但两者差距逐步接近,在术后28 d以后趋于一致.比较术后第7、14、21和28 d时的用药量,A组分别为B组的72.74%、82.26%、83.92%和88.87%.在相关性分析中,A组移植物重量/受者体重（GR/WR）与其术后第7天所用Tac剂量（mg·kg-1·d-1）呈显著正相关（r=0.728,P＜0.01）;与全血Tac浓度/剂量（C/D值）之间呈显著负相关（r=-0.644,P＜0.01）.结论 活体部分肝移植术后,其早期Tac用量与植入供肝体积显著相关;成人活体右半供肝移植术后的早期用量约相当于尸体全肝移植术后的70%.随着植入供肝的不断再生,至术后28 d时Tac的用量可基本接近尸体全肝移植水平.Objective To compare the metabolic characteristics, dosages and blood concentrations of tacrolimus （Tac） in patients subject to cadaveric liver transplantation （CLT） vs living-donor partial liver transplantation （LDLT） in order to investigate the usage of Tac in patients undergoing LDLT. Methods The clinical data of 85 patients undergoing liver transplantation from April 2007 to September 2009 were analyzed retrospectively. Thirty-four underwent LDLT （group A）and the remaining 51 underwent CLT （group B）. Results The time to reach therapeutic window was shorter in group A （3. 4 ± 1.0 days） than in group B （4. 5 ± 2. 0 days, P = 0. 002）. The Tac dosage in group A was significantly less than in group B during the first 28 days post-transplantation. However,the Tac dosage approached gradually and tended to be consistent after 28 days. On the postoperative day7, 14, 21 and 28 days, the Tac dosage in group A was 72.74 ％, 82.26 ％, 83.92 ％ and 88. 87 ％ of that in group B respectively. Correlation analysis revealed that graft-recipient body weight ratio （GR/WR） was significantly correlated with the Tac dosage on the day 7 （mg·day-1 · kg-1） （r =0. 728, P＜0. 01） and Tac concentration/dosage ratio （ng/ml）/（mg/kg） （r = - 0. 644, P＜0. 01 ）.Conclusion The early Tac dosages in patients subject to LDLT were correlated significantly with the volume of graft. The early Tac dosages in patients undergoing LDLT were about 70 ％ of those in patients undergoing cadaveric liver transplantation. Moreover, with the regeneration of the liver, they tended to be consistent after 28 days.

关 键 词：肝移植 活体供者 他克莫司 

分 类 号：R686[医药卫生—骨科学]