Renz J F, Lightdale J, Mudge C, Bacchetti P, Watson J, Ascher N L, Emond J C, Rosenthal P, Roberts J P
Department of Surgery, Division of Transplantation, University of California, San Francisco, CA, USA.
Liver Transpl Surg. 1999 Mar;5(2):136-43. doi: 10.1002/lt.500050208.
Triple immunosuppressive therapy using mycophenolate mofetil (MMF), microemulsion cyclosporine (me-CsA), and prednisone offers the potential for potent immunosuppression without intravenous drug therapy or anti-T-cell antibody induction therapy. This report describes the application of an immunosuppressive protocol (CNp) using MMF, me-CsA, and prednisone as primary immunosuppression for pediatric liver transplant recipients at the University of California at San Francisco. From August 1995 through December 1996, 26 children (17 boys, 9 girls) aged 1 month to 16 years (mean +/- standard deviation, 58 +/- 62 months; median, 31 months) underwent liver transplantation at our institution, receiving CNp as primary immunosuppression. Posttransplantation renal function, incidence of leukopenia, and drug tolerance within the group receiving CNp as primary immunosuppression were compared with those of 19 children who received primary immunosuppression consisting of azathioprine, oil-based gel-encapsulated cyclosporine, and prednisone with anti-T-cell antibody induction therapy at the same institution from October 1993 through July 1995. No significant difference was observed between immunosuppressive protocols in serum creatinine level or incidence of leukopenia requiring medical therapy during the first year posttransplantation. Whereas gastrointestinal symptoms were observed in approximately 30% of CNp recipients during initial immunotherapy, tolerance of CNp primary immunotherapy was routinely achieved by the dose reduction of MMF. At 1 year posttransplantation, 20 children (77%) remained on CNp primary immunotherapy, 5 children (19%) were receiving tacrolimus-based immunotherapy secondary to rejection, and 1 patient (4%) converted to tacrolimus-based immunotherapy secondary to persistent gastrointestinal intolerance. In conclusion, CNp provides an alternative immunosuppressive protocol that eliminates the necessity of intravenous and induction immunosuppressive therapy with no increased incidence of posttransplantation renal dysfunction or leukopenia and is well tolerated in children.
使用霉酚酸酯（MMF）、微乳化环孢素（me-CsA）和泼尼松的三联免疫抑制疗法，提供了无需静脉药物治疗或抗T细胞抗体诱导疗法即可实现强效免疫抑制的可能性。本报告描述了一种免疫抑制方案（CNp）在加利福尼亚大学旧金山分校用于小儿肝移植受者的情况，该方案使用MMF、me-CsA和泼尼松作为主要免疫抑制剂。从1995年8月至1996年12月，26名年龄在1个月至16岁（平均±标准差，58±62个月；中位数，31个月）的儿童（17名男孩，9名女孩）在我们机构接受了肝移植，并接受CNp作为主要免疫抑制治疗。将接受CNp作为主要免疫抑制治疗组的移植后肾功能、白细胞减少症发生率和药物耐受性，与1993年10月至1995年7月在同一机构接受由硫唑嘌呤、油基凝胶包封环孢素和泼尼松联合抗T细胞抗体诱导疗法组成的主要免疫抑制治疗的19名儿童进行了比较。在移植后第一年，两种免疫抑制方案在血清肌酐水平或需要药物治疗的白细胞减少症发生率方面未观察到显著差异。虽然在初始免疫治疗期间约30%的CNp接受者出现胃肠道症状，但通过减少MMF剂量通常可实现对CNp主要免疫治疗的耐受。移植后1年，20名儿童（77%）仍接受CNp主要免疫治疗，5名儿童（19%）因排斥反应接受基于他克莫司的免疫治疗，1名患者（4%）因持续的胃肠道不耐受而转换为基于他克莫司的免疫治疗。总之，CNp提供了一种替代的免疫抑制方案，消除了静脉和诱导免疫抑制治疗的必要性，且移植后肾功能障碍或白细胞减少症的发生率没有增加，并且在儿童中耐受性良好。
