Nagahama Kanji, Yamamoto Shingo, Yoshida Hiroshi, Nakamura Eijiro, Ito Noriyuki, Kinoshita Hidefumi, Kamoto Toshiyuki, Okuno Hiroshi, Ogawa Osamu
Department of Urology Graduate School of Medicine, Kyoto University.
Hinyokika Kiyo. 2004 Sep;50(9):605-10.
We reviewed the outcome of three methods employed for living-related renal transplantation (RTx) in our institution to assess triple immunosuppressive regimens. Between January 1989 and July 2003, a total of 35 living-related RTxs were performed at our institution. The immunosuppressive regimen given to 16 patients (group A) was cyclosporine (CsA), steroid and azathoprine (AZ) that given to 9 patients (group B) was tacrolimus (TAC), steroid and AZ and that given 9 patients (group C) was TAC, steroid and mycophenolate mofetil (MMF). Graft survival rate, serum creatinine, proteinuria, acute rejection, chronic allograft nephropathy (CAN), cytomegalovirus (CMV) infection and drug-induced nephropathy were investigated. There was no significant difference in graft survival rate among the three groups. Although serum creatinine levels (mg/dl) at 3 months post-transplant were 1.22+/-0.37 in group A, 1.43+/-0.14 in group B, 1.30+/-0.34 in group C, respectively (p<0.05; A vs. B), there was no significant difference at 1 year post-transplant. Frequency of proteinuria in groups A, B and C was 75.0, 50.0, 25.0%, respectively (p<0.05; A vs. C). The incidences of acute rejection and CAN within 1 year post-transplant were, respectively, 56.3% and 43.8% in group A, 37.5% and 37.5% in group B; and, 25.0% and 12.5% in group C (NS). The incidence of drug-induced nephrotoxicity was 12.5, 50.0% and 37.5% in groups A, B and C, respectively (p<0.05; A vs. B). The triple immunosuppressive therapy including calcineurin inhibitors, especially the regime of TAC, MMF, and steroids decreased the frequencies of proteinuria and rejections, which deteriorated the long-term outcome in living-related RTxs.
我们回顾了我院采用的三种亲属活体肾移植(RTx)方法的结果,以评估三联免疫抑制方案。1989年1月至2003年7月,我院共进行了35例亲属活体肾移植。给予16例患者(A组)的免疫抑制方案为环孢素(CsA)、类固醇和硫唑嘌呤(AZ);给予9例患者(B组)的是他克莫司(TAC)、类固醇和AZ;给予9例患者(C组)的是TAC、类固醇和霉酚酸酯(MMF)。我们对移植肾存活率、血清肌酐、蛋白尿、急性排斥反应、慢性移植肾肾病(CAN)、巨细胞病毒(CMV)感染和药物性肾病进行了研究。三组之间的移植肾存活率无显著差异。虽然移植后3个月时A组、B组、C组的血清肌酐水平(mg/dl)分别为1.22±0.37、1.43±0.14、1.30±0.34(p<0.05;A组与B组),但移植后1年时无显著差异。A组、B组和C组的蛋白尿发生率分别为75.0%、50.0%、25.0%(p<0.05;A组与C组)。移植后1年内急性排斥反应和CAN的发生率在A组分别为56.3%和43.8%,B组为37.5%和37.5%;C组为25.0%和12.5%(无显著性差异)。A组、B组和C组药物性肾毒性的发生率分别为12.5%、50.0%和37.5%(p<0.05;A组与B组)。包括钙调神经磷酸酶抑制剂的三联免疫抑制治疗,尤其是TAC、MMF和类固醇方案,降低了蛋白尿和排斥反应的发生率,而这会使亲属活体肾移植的长期结果恶化。