Demetris A J, Fung J J, Todo S, McCauley J, Jain A, Takaya S, Alessiani M, Abu-Elmagd K, Van Thiel D H, Starzl T E
Department of Pathology, Presbyterian University Hospital, University of Pittsburgh, Pennsylvania 15213.
Transplantation. 1992 May;53(5):1056-62. doi: 10.1097/00007890-199205000-00017.
The effect of conversion from cyclosporine-steroid immunosuppression to the new agent FK506 was studied in 96 liver allograft recipients who were experiencing graft dysfunction or cyclosporine toxicity. Patients were stratified according to the cause of graft dysfunction that ultimately led to conversion to FK506. Response to FK506 introduction was monitored pathologically and biochemically. The outcome of a switch from CsA to FK506 was highly favorable in patients experiencing acute and the early stages of chronic rejection, despite optimal conventional therapy. Patients with later stages of chronic rejection did not respond to conversion to FK506 and most eventually lost their liver grafts in this process. Patients in whom we had difficulty separating chronic rejection from chronic persistent or low-grade chronic active hepatitis were mostly unaffected by conversion to FK506. Active hepatitis was a poor indication for conversion, because most of the patients experienced graft failure or died from liver failure. As a group, there was no statistically significant change in renal function 180 days after conversion to FK506. These findings expand the experience with FK506 in human liver allograft recipients.
在96名出现移植物功能障碍或环孢素毒性的肝移植受者中，研究了从环孢素 - 类固醇免疫抑制转换为新药物FK506的效果。根据最终导致转换为FK506的移植物功能障碍原因对患者进行分层。通过病理和生化方法监测对引入FK506的反应。尽管采用了最佳的传统治疗方法，但从环孢素A转换为FK506对处于急性和慢性排斥反应早期的患者非常有利。慢性排斥反应后期的患者对转换为FK506无反应，并且在此过程中大多数最终失去了肝脏移植物。难以区分慢性排斥反应与慢性持续性或低度慢性活动性肝炎的患者大多不受转换为FK506的影响。活动性肝炎是转换的不良指征，因为大多数患者经历了移植物衰竭或死于肝功能衰竭。作为一个群体，转换为FK506 180天后肾功能没有统计学上的显著变化。这些发现扩展了FK506在人类肝移植受者中的应用经验。
