Abstract:

Objective To study the efficacy and safety of mycophenolate mofetil（MMF）in pediatric liver transplantation. Methods We retrospectively analyzed the clinical data of 18 cases of pediatric liver transplantations performed from August 2013 to August 2014 in Tianjin first central hospital，of which 12 caseswere treated with MMF. Results Among these 18 recipients，1 suffered biliary-enteric anastomosis intestinalfistula 2 weeks after operation，and no severe surgical complications were observed in other 17 cases. MMF wasadministrated in 8 cases for acute rejection and 4 cases for low tacrolimus concentration. Alanine aminotransferase （ALT）decreased significantly in those 8 recipients with acute rejection after administration of MMF（39 U/Lvs. 233 U/L，P ＝ 0.007）. Aspartate aminotransferase（AST），total bilirubin（TBil）and alkaline phosphatase（ALP）also decreased，but there were no statistically significant differences（P value were 0.05，0.19 and 0.06 respectively）.Liver function was normal in all cases till September 2014. In 6 recipients without administration of MMF，2 casessuffered EB virus infection，while in 12 recipients with administration of MMF，3 cases suffered EB virus infectionwith 2 out of these 3 with cytomegalovirus infection. 1 case suffered MMF-induced diarrhea. Bone marrow suppression was not observed in all cases. Despite the EB virus infection，no posttransplant lymphoproliferative disorders（PTLD）and other malignant tumors were observed in this cohort. Conclusion MMF is an effective immunosuppressant for treatment and prevention of acute rejection in pediatric liver transplantation without significant side effects.

摘要：

目的 研究霉酚酸酯（MMF）类药物在儿童肝移植中应用的有效性及安全性。方法 回顾性分析天津市第一中心医院 2013 年 8 月至 2014 年 8 月间进行肝移植手术后 18 例患儿的临床资料，对其中12 例加用 MMF 药物治疗的患儿进行观察。结果 18 例肝移植患儿中除 1 例患儿术后 2 周出现胆肠吻合肠袢肠瘘，其余 17 例患儿均未出现严重外科并发症。8 例患儿因为急性排斥反应而加用 MMF，4 例患儿因他克莫司血药浓度偏低加用 MMF。8 例存在急性排斥反应的患儿，加用 MMF 后丙氨酸转氨酶（ALT）显著下降（39 U/L 比 233 U/L，P ＝ 0.007）；天冬氨酸转氨酶（AST）、总胆红素（TBil）、碱性磷酸酶（ALP）均较加用 MMF 前降低，但差异无统计学意义（P 值分别为 0.05、0.19 和 0.06）。随访至 2014 年 9 月，所有患儿肝功能均恢复正常。6 例未加用 MMF 的患儿中，2 例出现 EB 病毒（EBV）感染，而在 12 例加用 MMF 后患儿中，有 3 例出现 EBV 感染，其中 2 例合并巨细胞病毒（CMV）感染。1 例患儿加用 MMF 后出现药物性腹泻。所有病例均未出现明显的骨髓抑制。虽然有EBV感染病例，但未出现移植后淋巴增殖性疾病（PTLD），也没有其他恶性肿瘤发生。结论 MMF 在儿童肝移植中是有效的免疫抑制剂，对于急性排斥反应的治疗及预防均有作用，而其毒副作用并未在患儿中有明显表现。

关键词: