Tanabe K, Takahashi K, Sonda K, Yagisawa T, Oba S, Nakazawa H, Goya N, Yamaguchi Y, Fuchinoue S, Nakamura M
Department of Urology and Surgery, Tokyo Women's Medical College.
Nihon Hinyokika Gakkai Zasshi. 1992 Apr;83(4):528-35. doi: 10.5980/jpnjurol1989.83.528.
We performed in total 528 kidney transplantations from Feb. 1983 to Dec. 1988 in Kidney Center of Tokyo Women's Medical College. Of the 528 kidney transplantations, 450 were living related kidney transplantations. The living related renal transplant recipients treated with CYA were divided into 3 groups: high dose CYA double drug therapy group (group 1), high dose CYA triple drug therapy group (group 2) and low dose CYA triple drug therapy group (group 3). Group 1 (n = 263) was treated with CYA (initial dose 12 mg/kg) and methylprednisolone (MP). Group 2 (n = 106) was treated with CYA (initial dose 10 mg/kg), MP and azathioprine (AZ) (1 mg/kg). Immunosuppression of group 3 (n = 81) consisted of CYA (initial dose 6 mg/kg), MP and AZ (2 mg/kg) (or mizoribine (MZ) (3-5 mg/kg). CYA serum trough level (polyclonal) was lowered according to the initial dose of CYA, and in particular trough level in group 3 was controlled at a low level (50-150 ng/ml in induction phase) to reduce CYA nephrotoxicity. However, even if strict control of serum trough level was accomplished, we could not get improvement of renal function in Group 3. Group 3 had more frequent and severe accelerated acute rejections (AAR) than the other groups. These data showed that inadequate immunosuppression in group 3 caused more frequent and severe rejection episodes. Also, renal biopsy revealed CYA nephrotoxicity even in group 3 and this nephrotoxicity may have been caused by ischemic damage by severe rejections.(ABSTRACT TRUNCATED AT 250 WORDS)
1983年2月至1988年12月期间，我们在东京女子医科大学肾脏中心共进行了528例肾移植手术。在这528例肾移植手术中，有450例是亲属活体肾移植。接受环孢素（CYA）治疗的亲属活体肾移植受者被分为3组：高剂量CYA双药治疗组（第1组）、高剂量CYA三联药治疗组（第2组）和低剂量CYA三联药治疗组（第3组）。第1组（n = 263）接受CYA（初始剂量12 mg/kg）和甲基泼尼松龙（MP）治疗。第2组（n = 106）接受CYA（初始剂量10 mg/kg）、MP和硫唑嘌呤（AZ）（1 mg/kg）治疗。第3组（n = 81）的免疫抑制方案包括CYA（初始剂量6 mg/kg）、MP和AZ（2 mg/kg）（或咪唑立宾（MZ）（3 - 5 mg/kg）。CYA血清谷浓度（多克隆）根据CYA的初始剂量降低，特别是第3组的谷浓度被控制在较低水平（诱导期为50 - 150 ng/ml）以降低CYA肾毒性。然而，即使严格控制血清谷浓度，第3组的肾功能仍未得到改善。第3组比其他组有更频繁、更严重的加速急性排斥反应（AAR）。这些数据表明，第3组免疫抑制不足导致了更频繁、更严重的排斥反应。此外，肾活检显示即使在第3组也存在CYA肾毒性，这种肾毒性可能是由严重排斥反应引起的缺血性损伤所致。（摘要截取自250字）
