Practical Journal of Organ Transplantation(Electronic Version) ›› 2013, Vol. 1 ›› Issue (3): 147-151.

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Dose optimization of triple immunosuppressive therapy in renal transplantation

PAN Xiao-ming,XUE Wu-jun,TIAN Pu-xun,DING Xiao-ming,YAN Hang,FENG Xin-shun,XIANG He-li,HOU Jun,DING Chen-guang,LI Yang.   

  1. Center of Nephrology,First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China
  • Online:2013-05-20 Published:2021-04-27

肾移植三联免疫抑制剂应用合适剂量的探讨

潘晓鸣,薛武军,田普训,丁小明,燕航,冯新顺,项和立,侯军,丁晨光,李杨   

  1. 西安交通大学医学院第一附属医院肾病中心,陕西 西安 710061
  • 基金资助:

    国家重点基础研究发展计划(973)项目(2009CB522407);

    国家自然科学基金(81100179)

Abstract:

Objective To optimize triple immunosuppressive dose in renal transplantation. Methods According to the dose of triple combined immunosuppressive regimen,200 patients were divided into conventional dose group(n145)and low-dose group(n128). The dose of immunosuppressive regimen at two,four weeks two,three and six months post-transplantation,the incidences of acute rejection,pulmonary infection and patient/graft survival rate were compared respectively between the two groups. Results The dose of triple immunosuppressive agents in the low-dose group was significantly lower than that in conventional dose group at six months post-transplantation. During the first six months post-transplantation,acute rejection including biopsy-proven and clinical presumed acute rejection occurred in 24 of 145 patients16.5%)in the conventional dose group,and in 24 of 128 patients18.7%)in the low-dose group(P0.05). At six months post-transplantation,pulmonary infection especially severe pulmonary infection,had a significantly higher occurrence in the conventional dose than in the low-dose group30.4% vs 10.2% and 22.1% vs 4.7% respectively,both P0.01). At 12 months,patient survival rate was 89.7% and 98.4%(P0.01),while the graft survival rate was 86.9% and 96.9%(P0.01)in the conventional dose group and low-dose group respectively. Excluding the death caused by infection with normal renal function,no significant difference was noted between the two groups(P0.05). Conclusion The low-dose combination of triple immunosuppressive agents post-transplantation can significantly reduce the pulmonary infection and mortality without increasing the incidence and severity of acute rejection and subclinical rejection.

Key words:

摘要:

目的 探讨肾移植术后三联免疫抑制剂应用的合适剂量。方法 比较常规剂量组(145 例) 和低剂量组(128 例)肾移植术后患者三联免疫抑制剂用量和急性排斥反应、肺部感染发生率和人 / 移植肾 生存率。结果 环孢素 A(CsA)和吗替麦考酚酯(MMF)用量在术后 6 个月内常规剂量组明显高于低剂量组。常规剂量组在 6 个月内包括活检证实和临床推断,其总的急性排斥发生率为 16.5%,而低剂量组为 18.7%,两组间差异无统计学意义(P0.05)。两组患者在 6 个月内肺部感染发生率分别为 30.4% 10.2% (P0.01),尤其是重症肺部感染发生率常规剂量组明显要高(22.1% 4.7%,P0.01)。常规剂量组和 低剂量组患者人 / 1 年生存率分别为 89.7%/86.9% 98.4%/96.9%(P0.01)。排除感染所致的带功死亡后两组患者人 / 1 年生存率差异无统计学意义。结论 低剂量三联免疫抑制剂应用并不增加急性排斥率、 亚临床排斥发生率、排斥治疗逆转率和排斥反应的严重程度,但明显降低肺部感染发生率和病死率。

关键词:

肾移植 , 免疫抑制 , 排斥