胰肾联合移植后的血栓性微血管病

Thrombotic microangiopathy after simultaneous pancreas-kidney transplantation.

作者信息

Rangel Erika B, Gonzalez Adriano M, Linhares Marcelo M, Araújo Sérgio R R, Franco Marcello F, de Sá João R, Pestana José O M, Melaragno Cláudio S

机构信息

Nephrology Division, Universidade Federal de São Paulo, Brazil.

出版信息

Clin Transplant. 2007 Mar-Apr;21(2):241-5. doi: 10.1111/j.1399-0012.2006.00633.x.

DOI:10.1111/j.1399-0012.2006.00633.x

PMID:17425752

Abstract

Thrombotic microangiopathy (TMA) is rare after transplantation and is associated with a high incidence of kidney graft dysfunction. Between December 2000 and March 2006, 136 simultaneous pancreas-kidney transplantations were performed with an incidence of TMA of 5.1% (71.4% localized to kidney allograft). All cases were diagnosed during the first three months and were attributed to tacrolimus; 74% were women. Systemic TMA presented higher values of lactate dehydrogenase (2658 +/- 659 U/L vs. 1331 +/- 473 U/L, p = 0.04) and a greater decrease in hematocrit (45.8 +/- 17.7% vs. 19.2 +/- 6%, p = 0.02) than in localized TMA. Acute kidney rejection complicated almost 90% of the cases with 43% of kidney graft lost. Tacrolimus was switched to sirolimus and fresh-frozen plasma was administered. Creatinine clearance after a mean follow-up of two yr was 100.7 mL/min/1.73 m(2) and 57.9 mL/min/1.73 m(2) in patients with systemic and localized TMA, respectively. In conclusion, sirolimus is an alternative to TMA associated with tacrolimus.

摘要

移植后血栓性微血管病（TMA）较为罕见，且与肾移植功能障碍的高发生率相关。在2000年12月至2006年3月期间，共进行了136例胰肾联合移植，TMA发生率为5.1%（71.4%局限于肾移植）。所有病例均在头三个月内确诊，且归因于他克莫司；74%为女性。与局限性TMA相比，系统性TMA的乳酸脱氢酶水平更高（2658±659 U/L对1331±473 U/L，p = 0.04），血细胞比容下降幅度更大（45.8±17.7%对19.2±6%，p = 0.02）。近90%的病例并发急性肾排斥，43%的肾移植失功。将他克莫司换为西罗莫司并给予新鲜冰冻血浆。系统性和局限性TMA患者平均随访两年后的肌酐清除率分别为100.7 mL/min/1.73 m²和57.9 mL/min/1.73 m²。总之，西罗莫司是与他克莫司相关的TMA的一种替代药物。