Fukuhara Nobuyuki, Ono Yoshinari, Hattori Ryohei, Nishiyama Naoki, Yamada Shin, Kamihira Osamu, Kinukawa Tsuneo, Ohshima Shinichi
Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Clin Transplant. 2005 Apr;19(2):153-7. doi: 10.1111/j.1399-0012.2005.00200.x.
Tacrolimus (Tac), developed in 1990, has been applied as an immunosuppressive agent for liver, heart, and kidney transplantation and is known to have more powerful immunosuppressive effects than cyclosporine (CyA). To evaluate the efficacy of Tac in cadaveric kidney transplants from non-heart beating donors, we present the long-term outcome of patients receiving kidneys with ischemic damage, and compared it with that of CyA. Between July 1990 and December 2000, 55 patients with end-stage renal disease received kidneys from non-heart beating donors (Maastrichy category 3) and were treated with Tac and steroid immunosuppressive therapy. During the same period, we also performed 137 non-heart beating cadaveric renal transplants treated with CyA-based immunosuppressive therapy. The patient survival rate was 98% at 1 yr and 96% at 3-10 yr in the Tac group, and 97% at 1-3 yr, 93% at 5 yr and 85% at 10 yr in the CyA group. The graft survival rate was 91% at 1 yr, 80% at 3 yr, 63% at 5 yr and 34% at 10 yr in the Tac group, and 88% at 1 yr, 75% at 3 yr, 63% at 5 yr and 49% at 10 yr in the CyA group. There was no significant difference in either patient or graft survival rates between the two groups. Acute early rejection in the Tac group was less than that in the CyA group but acute tubular necrosis was the same in both groups. This indicates that Tac is available for cadaveric kidney transplants from non-heart beating donors. In conclusion, Tac is available as an immunosuppressive agent even for kidney transplants from non-heart beating donors.
他克莫司（Tac）于1990年研发出来，已被用作肝脏、心脏和肾脏移植的免疫抑制剂，并且已知其具有比环孢素（CyA）更强的免疫抑制作用。为了评估他克莫司在非心脏跳动供体的尸体肾移植中的疗效，我们展示了接受有缺血损伤肾脏的患者的长期结果，并将其与环孢素组进行比较。1990年7月至2000年12月期间，55例终末期肾病患者接受了非心脏跳动供体（马斯特里赫特3级）的肾脏，并接受了他克莫司和类固醇免疫抑制治疗。在同一时期，我们还进行了137例采用基于环孢素的免疫抑制治疗的非心脏跳动尸体肾移植。他克莫司组1年时患者生存率为98%，3至10年时为96%；环孢素组1至3年时为97%，5年时为93%，10年时为85%。他克莫司组1年时移植物生存率为91%，3年时为80%，5年时为63%，10年时为34%；环孢素组1年时为88%，3年时为75%，5年时为63%，10年时为49%。两组患者和移植物生存率均无显著差异。他克莫司组急性早期排斥反应低于环孢素组，但两组急性肾小管坏死情况相同。这表明他克莫司可用于非心脏跳动供体的尸体肾移植。总之，即使对于非心脏跳动供体的肾移植，他克莫司也可作为一种免疫抑制剂使用。
