The evolution of immunosuppression with FK506 in pediatric living-related liver transplantation
The evolution of immunosuppression with FK506 in pediatric living-related liver transplantation
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DOI：
10.1097/00007890-199601270-00015
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发表时间：
1996-01-27
期刊：
影响因子：
6.2
通讯作者：
Hashida, T
中科院分区：
文献类型：
--
作者：
Inomata, Y;Tanaka, K;Hashida, T
回顾性研究了三种FK 506诱导方案对儿童活体肝移植（LRLT）患者生存率和不良副作用的影响。这些患者包括120名儿童，年龄从3个月到210个月不等，共接受了122次LRLT，至少随访6个月。免疫抑制剂包括FK 506和低剂量类固醇。FK 506分3种给药方式：（1）大剂量静脉注射（i. v.）诱导，前16例患者以0.15 mg/kg/天剂量开始FK 506;（2）低剂量i. v.诱导，后45例患者以0.06 mg/kg/天剂量开始FK 506;和（3）口服（p.o.）诱导期，从LRLT前一天开始口服FK 506，术后继续，每天监测FR 506的全血谷水平。高诱导组中的谷水平通常高达100 ng/ml，而p.o.组中的水平为20 ng/ml。诱导组，高i. v. vs.低i. v. vs. p.o.患者存活率分别为75%、89%和80%。急性排斥反应发生率分别为12.5%、22.2%和26.4%，病毒感染发生率分别为56%、38%和11%。在高剂量静脉注射诱导组中，主要不良反应的发生频率更高。从LRLT前一天开始以0.15 mg/kg/天剂量口服FK 506诱导治疗比静脉注射FK 506治疗更安全，且病毒感染发生率更低。
The effects of three FK506 induction regimens on pediatric living-related liver transplantation (LRLT) were studied retrospectively in terms of patient survival and adverse side effects. The patients consisted of 120 children, ranging from 3 to 210 months of age, who underwent a total of 122 LRLTs with a minimum follow-up of 6 months. Immunosuppression consisted of FK506 and low-dose steroids. FK506 was given in 3 ways: (1) high-dose intravenous (i.v.) induction, with FK506 begun at a dose of 0.15 mg/kg/day for the first 16 patients; (2) low-dose i.v. induction, with FK506 begun at a dose of 0.06 mg/kg/day for the next 45 patients; and (3) per os (p.o.) induction, with FK506 begun orally from the day prior to LRLT and continued postoperatively, Whole-blood trough levels of FR506 were monitored daily. Trough levels in the high induction group were often as high as 100 ng/ml compared with the level of 20 ng/ml in the p.o. induction group, Patient survivals were 75%, 89%, and 80% in the high-i.v. vs. low-i.v. vs. p.o. groups, The incidences of acute rejection were 12.5%, 22.2%, and 26.4%, and the incidences of viral infection were 56%, 38%, and 11% in the respective groups. Major adverse effects occurred with higher frequency in the high-i.v. induction group. Oral FK506 induction therapy at a dose of 0.15 mg/kg/day starting from the day before LRLT was safer and associated with a lower incidence of viral infection than therapy with i.v. FK506.