Lin Chih-Che, Chuang Feng-Rong, Lee Chih-Hsiung, Wang Chih-Chi, Chen Yaw-Sen, Liu Yueh-Wei, Jawan Bruno, Chen Chao-Long
Liver Transplant Program, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niao-Sung, Kaohsiung, Taiwan.
Liver Transpl. 2005 Oct;11(10):1258-64. doi: 10.1002/lt.20520.
The purpose of this study is to find out whether basiliximab administration will improve postoperative renal function by delaying the start of tacrolimus and decreasing of dosage requirement for tacrolimus in adult living donor liver transplantation (LDLT). Forty-five adult LDLT recipients were enrolled in the study. The induction group (n = 27) was given basiliximab 20 mg on days 0 and 4; tacrolimus administration was delayed until renal function improved. The control group (n = 18) did not receive basiliximab; tacrolimus was given on the first postoperative day. Trough levels of tacrolimus in the induction and control groups were aimed to be maintained at 5-10 ng/ml and 10-15 ng/ml during the first week after transplant, respectively. The median follow-up was 22 months (range 10-34 months). The preoperative conditions were poorer in the induction group (Child C, 56% vs. 33%, P = 0.01; UNOS 2a, 15% vs. 0%, P = 0.02). The intraoperative blood loss was also higher in the induction group than in the control group (median 2,180 ml vs. 495 ml, P < 0.01). The median delay in tacrolimus administration in the induction group was 36 hours (range 24-108 hours). Serum creatinine levels at second and third postoperative months were significantly lower in the induction group. The creatinine clearance rate in the induction group was higher at the third month posttransplant (median 72 vs. 57 ml/minute, P = 0.04). The incidence of renal insufficiency was significantly lower in the induction group at the third month posttransplant (26% vs. 67%, P < 0.01). Blood cholesterol level at the sixth month posttransplant was lower in the induction group (median 152 vs. 196 mg/dl P = 0.03). The incidences of acute cellular rejection, bacteremia, and cytomegalovirus (CMV) infection were similar in both groups. In conclusion, for pretransplant critical patients with more intraoperative blood loss, basiliximab induction could prevent early renal dysfunction by delaying the start of tacrolimus and reducing the dose requirement of tacrolimus without increasing graft rejection and infection. Furthermore, it also improved renal function as well as lowered cholesterol levels within 6 months after transplantation.
本研究的目的是探究在成人活体肝移植（LDLT）中，使用巴利昔单抗是否能通过延迟他克莫司的起始使用时间并降低其剂量需求来改善术后肾功能。45例成人LDLT受者纳入本研究。诱导组（n = 27）在第0天和第4天给予20 mg巴利昔单抗；他克莫司的使用延迟至肾功能改善。对照组（n = 18）未接受巴利昔单抗；术后第一天即给予他克莫司。移植后第一周，诱导组和对照组他克莫司的谷浓度分别旨在维持在5 - 10 ng/ml和10 - 15 ng/ml。中位随访时间为22个月（范围10 - 34个月）。诱导组术前情况较差（Child C级，56%对33%，P = 0.01；UNOS 2a级，15%对0%，P = 0.02）。诱导组术中失血量也高于对照组（中位值2180 ml对495 ml，P < 0.01）。诱导组他克莫司给药的中位延迟时间为36小时（范围24 - 108小时）。术后第二个月和第三个月时，诱导组的血清肌酐水平显著更低。移植后第三个月时，诱导组的肌酐清除率更高（中位值72对57 ml/分钟，P = 0.04）。移植后第三个月时，诱导组肾功能不全的发生率显著更低（26%对67%，P < 0.01）。移植后第六个月时，诱导组的血胆固醇水平更低（中位值152对196 mg/dl，P = 0.03）。两组急性细胞性排斥反应、菌血症和巨细胞病毒（CMV）感染的发生率相似。总之，对于移植前病情危急且术中失血较多的患者，巴利昔单抗诱导治疗可通过延迟他克莫司的起始使用时间和降低他克莫司的剂量需求来预防早期肾功能障碍，且不增加移植物排斥反应和感染的发生。此外，它还能改善肾功能，并在移植后6个月内降低胆固醇水平。
