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背景:亲属活体肾移植供、受者移植前准备充分,供肾热、冷缺血时间较短,HLA配型的组织相容性好,移植后排斥反应发生率低,为亲属活体供肾肾移植后采用低剂量免疫抑制剂方案提供了可能性。目的:探讨亲属活体供肾移植后低剂量钙调蛋白酶抑制剂的安全性和有效性。方法:选取2006-01/2008-06在南京医科大学第一附属医院肾移植中心行亲属活体供肾移植的受者38例,移植后常规使用环孢素A/他克莫司+吗替麦考酚酯+泼尼松的三联免疫抑制方案。将38例患者随机分为两组:CNI常规剂量组(n=18),移植后初始药物剂量为环孢素A6mg/(kg·d)或他克莫司0.12mg/(k·d);CNI低剂量组(n=20),术后初始药物剂量为环孢素A4mg/(kg·d)或他克莫司0.08mg/(kg·d);两组吗替麦考酚酯和泼尼松使用剂量相同。移植后密切随访,比较两组患者移植后不同时期的肾功能以及急性排斥反应、肺部感染、肝功能损害、肾毒性等并发症的发生情况。结果与结论:随访12个月,CNI常规剂量组重度肺部感染死亡1例,CNI低剂量组无死亡病例。两组移植肾功能及急性排斥反应发生率比较差异均无显著性意义(P>0.05);CNI低剂量组肝功能损害、钙调蛋白酶抑制剂肾毒性发生率显著低于CNI常规剂量组(P<0.05)。此外,采用低剂量钙调蛋白酶抑制剂免疫抑制方案明显减轻了亲属肾移植患者的经济负担。说明亲属活体供肾移植后采用低剂量钙调蛋白酶抑制剂的免疫抑制剂方案安全、有效。
Background: Relatives of living donor kidney transplant recipients are well prepared before transplantation, with short duration of renal heat and cold ischemia, good histocompatibility of HLA matching, low incidence of rejection after transplantation, The possibility of using a low-dose immunosuppressive regimen after transplantation is provided. Objective: To investigate the safety and efficacy of low-dose calmodulin inhibitors after living donor kidney transplantation. Methods: Thirty-eight recipients of living donor kidney transplantation at the Renal Transplant Center of the First Affiliated Hospital of Nanjing Medical University from January 2006 to June 2008 were selected and routinely treated with cyclosporine A / tacrolimus + Cocaine ester + prednisone triple immunosuppressive regimen. Thirty - eight patients were randomly divided into two groups: CNI group (n = 18), initial dose of cyclosporin A 6mg / (kg · d) or tacrolimus 0.12mg / (k · d) In the low-dose CNI group (n = 20), the initial dose of ciclosporin A4mg / (kg · d) or tacrolimus 0.08mg / (kg · d) The same dosage of Nissan. After follow-up after transplantation, renal function, acute rejection, pulmonary infection, liver dysfunction, nephrotoxicity and other complications were compared between the two groups after transplantation. RESULTS AND CONCLUSION: In the 12-month follow-up, 1 died of severe pulmonary infection in the CNI conventional dose group and no death occurred in the CNI low dose group. There was no significant difference between the two groups in the incidence of renal allograft function and acute rejection (P> 0.05). The incidence of hepatic dysfunction and calmodulin nephrotoxicity in CNI low dose group was significantly lower than that of CNI conventional dose group <0.05). In addition, immunosuppression with a low-dose calmodulin inhibitor significantly reduced the financial burden on relative renal transplant recipients. It is safe and effective to use the immunosuppressive regimen of low-dose calmodulin inhibitor after living donor kidney transplantation.