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（n＝145）and low-dose group（n＝128）. 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 patients（16.5%）in the conventional dose group，and in 24 of 128 patients（18.7%）in the low-dose group（P＞0.05）. 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 group（30.4% vs 10.2% and 22.1% vs 4.7% respectively，both P＜0.01）. At 12 months，patient survival rate was 89.7% and 98.4%（P＜0.01），while the graft survival rate was 86.9% and 96.9%（P＜0.01）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（P＞0.05）. 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.

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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（P＞0.05）。两组患者在 6 个月内肺部感染发生率分别为 30.4% 和 10.2% （P＜0.01），尤其是重症肺部感染发生率常规剂量组明显要高（22.1% 比 4.7%，P＜0.01）。常规剂量组和 低剂量组患者人 / 肾 1 年生存率分别为 89.7%/86.9% 和 98.4%/96.9%（P＜0.01）。排除感染所致的带功死亡后两组患者人 / 肾 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