Rescue therapy with tacrolimus (FK 506) in renal transplant recipients - A Scandinavian multicenter analysis
Rescue therapy with tacrolimus (FK 506) in renal transplant recipients - A Scandinavian multicenter analysis
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DOI：
10.1111/j.1432-2277.1997.tb00530.x
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发表时间：
1997-01-01
影响因子：
3.1
通讯作者：
Persson, NH
中科院分区：
文献类型：
--
作者：
Felldin, M;Backman, L;Persson, NH
回顾性分析了1992年10月至1995年6月期间，瑞典和挪威的所有肾移植受者（n = 32）从环孢素（CyA）为基础的免疫抑制转换为FK 506（他克莫司）。转换的原因是急性难治性排斥反应（n = 21），慢性排斥反应（n = 4）和疑似CyA毒性（n = 6）; 1例患者因心理原因转换。从移植到转换的平均时间为29（范围1-243）周，平均随访46（2-143）周。移植物总存活率为59%，其中52%的患者因急性排斥反应而转换，50%的患者因慢性排斥反应而转换，83%的患者因CyA毒性而转换。转换前血清肌酐与预后无显著相关性。72%的患者在FK 506治疗期间出现了明显的副作用，最常见的是神经系统和胃肠道症状。这些在剂量减少后改善。两名患者成为过度免疫抑制和发展淋巴瘤。1例患者死于原发性肾脏疾病，溶血性尿毒症综合征。我们得出结论，FK 506治疗能够挽救急性难治性排斥反应的肾脏，它是CyA毒性患者的替代方案。但是，必须考虑过度免疫抑制的风险。
All renal allograft recipients (n = 32) in Sweden and Norway who were converted from cyclosporin(CyA)-based immunosuppression to FK 506 (tacrolimus) between October 1992 and June 1995 were analyzed retrospectively. The reasons for conversion were acute refractory rejection (n = 21), chronic rejection (n = 4), and suspected CyA toxicity (n = 6); one patient was converted for psychological reasons. The mean time from transplantation to conversion was 29 (range 1-243) weeks and there was a mean follow-up of 46 (2-143) weeks. Overall graft survival was 59 %, with graft survival 52 % in patients converted because of acute rejection, 50 % in patients converted because of chronic rejection, and 83 % in patients converted because of CyA toxicity. There was no significant correlation between preconversion serum creatinine and outcome. Seventy-two percent of the patients had significant side effects during FK 506 treatment, the most frequent ones being neurological and gastrointestinal symptoms. These improved after dose reduction. Two patients became overimmunosuppressed and developed lymphoma. One patient died of the primary kidney disease, hemolytic uraemic syndrome. We conclude that FK 506 therapy is able to salvage kidneys with acute refractory rejection and that it is an alternative in patients with CyA toxicity. However, the risk of overimmunosuppression must be considered.