Tannuri Uenis, Gibelli Nelson E M, Maksoud-Filho João G, Santos Maria M, Pinho-Apezzato Maria Lucia, Velhote Manoel Carlos P, Ayoub Ali A R, Silva Marcos M, Maksoud João G
Liver Transplantation Unit, Children Institute, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil.
Pediatr Transplant. 2007 Feb;11(1):82-6. doi: 10.1111/j.1399-3046.2006.00631.x.
Few studies have evaluated the long-term use of MMF in liver transplanted children with renal dysfunction. The aim of this study is to report the experience of a pediatric transplantation center on the efficacy and security of long-term use of a MMF immunosuppressant protocol with reduced doses of CNIs in stable liver transplanted children with renal dysfunction secondary to prolonged use of CsA or Tac. Between 1988 and 2003, 191 children underwent OLT and 11 patients developed renal dysfunction secondary to CNIs toxicity as evaluated by biochemical renal function parameters. The interval between liver transplantation and the introduction of the protocol varied from one to 12 yr. Renal function was evaluated by biochemical parameters in five phases: immediately prior to MMF administration; 3, 6, 12 and 24 months after the introduction of MMF. Among the patients, nine of them (82%) showed improvement of renal function parameters in comparison with the pretreatment values. The two patients that did not show any improvement were patients in whom the interval of time between OLT and the introduction of MMF was longer. All parameters of liver function remained unchanged. No episodes of acute or chronic rejection or increases in infection rates during the period were detected. Two patients developed transitory diarrhea and leukopenia that were reverted with reduction of MMF dosage. In conclusion, in liver transplanted pediatric patients with CNI-induced chronic renal dysfunction, the administration of MMF in addition to reduced doses of CNIs promotes long-term improvement in renal function parameters with no additional risks.
很少有研究评估霉酚酸酯（MMF）在肾功能不全的肝移植儿童中的长期使用情况。本研究的目的是报告一个儿科移植中心在长期使用MMF免疫抑制方案（联合降低剂量的钙调神经磷酸酶抑制剂（CNIs））治疗因长期使用环孢素A（CsA）或他克莫司（Tac）导致肾功能不全的稳定肝移植儿童时的疗效和安全性经验。1988年至2003年间，191名儿童接受了原位肝移植（OLT），其中11名患者因生化肾功能参数评估显示出现了CNIs毒性继发的肾功能不全。肝移植与引入该方案之间的间隔时间为1至12年。通过生化参数分五个阶段评估肾功能：在给予MMF之前即刻；引入MMF后3、6、12和24个月。在这些患者中，9名（82%）患者的肾功能参数与治疗前值相比有所改善。未显示任何改善的两名患者是OLT与引入MMF之间间隔时间较长的患者。所有肝功能参数均保持不变。在此期间未检测到急性或慢性排斥反应发作或感染率增加。两名患者出现短暂性腹泻和白细胞减少，通过减少MMF剂量后恢复。总之，在因CNIs导致慢性肾功能不全的肝移植儿科患者中，除了降低剂量的CNIs外给予MMF可促进肾功能参数的长期改善且无额外风险。
