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目的 :探讨他克莫司 (FK5 0 6 )在移植肾功能延迟恢复 (DGF)患者中的临床应用价值与合理用药方案。 方法 :17例DGF患者临床结合移植肾病理确立诊断。肾移植术后早期均接受三联 (FK5 0 6 +MMF +Pred)免疫抑制药物治疗至少 3个月。不用任何生物制剂诱导治疗 ,观察临床疗效及副作用。 结果 :17例患者无一例死亡或摘除移植肾。 15例在术后第 2～ 3天开始血液透析 (HD) /连续性血液净化 (CBP)治疗 ,2例在术后第 5天开始HD/CBP。HD/CBP治疗 2～ 15次后 ,10例在术后 7天内停止 ,7例在术后 7天后仍需CBP治疗 ,最长 1例在术后第 18天停止透析。FK5 0 6治疗后 8～ 17天患者尿量开始明显增多 ,SCr开始明显下降。 17例患者诊断DGF时SCr水平在4 89～ 10 2 8μmol/L ,14例在治疗后 8～ 17天降至 <2 0 0 μmol/L ,另 3例中 2例SCr分别在术后第 2 4天 ,2 8天降至 <2 0 0 μmol/L。副作用主要是腹泻 (3例 ) ,血糖升高 (1例 )及手颤 ,肢体麻木 (4例 ) ,但未出现CMV等严重感染病例。 结论 :FK5 0 6 +MMF +Pred三联免疫抑制治疗方案治疗肾移植DGF安全有效 ,可作为肾移植术后DGF患者的过渡治疗方法之一
Objective: To investigate the clinical value and rational use of tacrolimus (FK506) in patients with delayed graft function (DGF). Methods: 17 cases of DGF patients with clinical diagnosis of renal allograft. Triplets (FK506 + MMF + Pred) immunosuppressive drugs were treated for at least 3 months early after renal transplantation. Without any induction of biological agents, to observe the clinical efficacy and side effects. RESULTS: None of the 17 patients had died or had their grafts removed. Fifteen patients underwent hemodialysis (HD) / continuous blood purification (CBP) 2 to 3 days after operation, and two of them started HD / CBP on the fifth day after operation. After 2 to 15 times of HD / CBP treatment, 10 patients stopped within 7 days after operation and 7 patients remained CBP after 7 days. The longest patient stopped dialysis on the 18th day after operation. FK5 0 8 8 to 17 days after treatment, patients began to significantly increased urine output, SCr began to decline significantly. In 17 cases, the level of SCr in the diagnosis of DGF was from 4 89 to 102 8 μmol / L, 14 cases dropped to <200 μmol / L 8 to 17 days after treatment, and the other 2 cases had SCr at 2 4 days, 28 days to <200 μmol / L. The main side effects were diarrhea (3 cases), hyperglycemia (1 case), hand tremor and limb numbness (4 cases), but no serious CMV infection occurred. Conclusion: FK5 0 6 + MMF + Pred triple immunosuppressive regimen is safe and effective in treating DGF after renal transplantation and may be used as a transitional treatment for DGF patients after renal transplantation