肝移植术后转换为以吗替麦考酚酯胶囊为主的免疫抑制方案的临床应用  

Altered use of Mycophenolate Mofetil Capsules-based immunosuppression therapy following liver transplantation

作　　者：杨星[1] 卢倩[1] 刘祥德[1] 廖睿[1] 杨占宇[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所肝脏移植中心,重庆400038

出　　处：《实用医院临床杂志》2011年第6期51-55,共5页Practical Journal of Clinical Medicine

摘　　要：目的探讨肝移植术后长期生存受者转换为以吗替麦考酚酯胶囊(商品名:骁悉)为主的免疫抑制方案的疗效及安全性。方法回顾性分析我中心肝移植术后长期生存受者中22例因钙神经蛋白抑制剂(calcineurin inhibitors,CNI)所致肝肾功能损害、高血压等原因转换为以吗替麦考酚酯胶囊为主的免疫抑制方案前后肝肾功能的改善情况及排斥反应和副作用的发生率。结果 8例受者因肾功能损害而转换为以吗替麦考酚酯胶囊为主的免疫抑制方案,其中7例(87.5%)在2个月内肾功能明显好转;4例肝功能损害,其中3例(75%)肝功能明显改善;9例受者逐渐减少CNI剂量,其中8例(88.9%)肝肾功能良好,未出现排斥反应,1例(4.5%)减量后6个月出现排斥反应,增加CNI剂量后治愈;1例因移植后高血压难以控制换用吗替麦考酚酯胶囊,其后监测血压在正常范围。1例(4.5%)换药后8个月出现白细胞减少,减少吗替麦考酚酯胶囊用量后白细胞恢复正常。结论肝移植术后长期应用CNI类药物发生肝肾功能损害、高血压等副作用时,转换为以吗替麦考酚酯胶囊为主的免疫抑制方案能有效控制排斥反应,改善毒副作用,且可为CNI的减量或停药提供机会。Objective To evaluate the altered use of Mycophenolate Mofetil Capsules-based immunosuppression therapy in long-term living recipients following liver transplantation.Methods Clinical data of 22 recipients shifted to Mycophenolate Mofetil Capsules-based immunosuppression therapy in our center were analyzed retrospectively.The indications for Mycophenolate Mofetil Capsules-based immunosuppression were calcineurin inhibitor（CNI）-related liver or renal toxicity,hypertension,etc.Results When the use of immunosuppressant was shifted to Mycophenolate Mofetil Capsules-based immunosuppression therapy in the 8 recipients with renal dysfunction,renal function was back to normal within 2 months in 7 cases.Liver function improved significantly in 3 of 4 recipients with liver insufficiency.Eight of nine recipients whose CNI doses were gradually reduced maintained liver and renal functions well without any rejection.One recipient shifted due to uncontrolled hypertension,and the blood pressure（BP） fell back to normal.With the new regime acute rejection developed in 1 cases,leukopenia in 1 cases.Those Mycophenolate Mofetil Capsules associated complications disappeared after increasing CNI dose and reducing Mycophenolate Mofetil Capsules dose.Conclusions The appropriate conversion to Mycophenolate Mofetil Capsules-based immunosuppression therapy is safe and effective in recipients with CNI-related liver or renal insufficiency after liver transplantation,and can provide an opportunity for withdrawal of CNI drugs.

关 键 词：肝移植 吗替麦考酚酯 免疫抑制 手术后 

分 类 号：R657.3[医药卫生—外科学] R619[医药卫生—临床医学]