Liu Fei, Li Ya, Lan Xiang, Wei Yong-Gang, Li Bo, Yan Lv-Nan, Wen Tian-Fu, Zhao Ji-Chun, Xu Ming-Qing, Wang Wen-Tao, Yang Jia-Yin
Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2009 Aug 21;15(31):3931-6. doi: 10.3748/wjg.15.3931.
To investigate the tacrolimus dosage requirements and blood concentrations in adult-to-adult right lobe living donor liver transplantation (AALDLT) recipients with small-for-size (SFS) grafts.
During January 2007 and October 2008, a total of 54 cases of AALDLT with an observation period of 6 mo were enrolled in this study. The 54 patients were divided into two groups according to graft-recipient body weight ratio (GRBW): SFS grafts group (Group S, GRBW < 0.8%, n = 8) and non-SFS grafts group (Group N, GRBW > or = 0.8%, n = 46). Tacrolimus 12-hour blood levels and doses were recorded during weeks 1, 2, 3 and 4 and months 2, 3, 4, 5 and 6 in group S and group N. Meanwhile, acute rejection rates, liver and renal function test results, and the number of potentially interacting medications were determined at each interval in the two groups. A comparison of tacrolimus dosage requirements and blood levels were made weekly in the first month post-surgery, and monthly from months 2 to 6.
There were no differences in the demographic characteristics, acute rejection rates, liver and renal function test results, or the number of potentially interacting medications administered between the two groups. The tacrolimus dosage requirements in group S were significantly lower than group N at 2 wk (2.8 +/- 0.4 mg/d vs 3.6 +/- 0.7 mg/d, P = 0.006), 3 wk (2.9 +/- 0.7 mg/d vs 3.9 +/- 0.8 mg/d, P = 0.008), 4 wk (2.9 +/- 0.8 mg/d vs 3.9 +/- 1.0 mg/d, P = 0.023) and 2 mo (2.8 +/- 0.7 mg/d vs 3.8 +/- 1.1 mg/d, P = 0.033). Tacrolimus 12-h trough concentrations were similar between the two groups at all times except for 2 wk post-transplantation, when the concentrations were significantly greater in group S recipients than in group N recipients (11.3 +/- 4.8 ng/mL vs 7.0 +/- 3.8 ng/mL, P = 0.026).
SFS grafts recipients have significantly decreased tacrolimus dosage requirements compared with non-SFS grafts recipients in AALDLT during the first 2 mo post-surgery.
探讨接受小体积（SFS）移植物的成人对成人右半肝活体肝移植（AALDLT）受者的他克莫司剂量需求及血药浓度。
2007年1月至2008年10月，共纳入54例AALDLT患者，观察期为6个月。根据移植物与受者体重比（GRBW）将54例患者分为两组：SFS移植物组（S组，GRBW<0.8%，n=8）和非SFS移植物组（N组，GRBW≥0.8%，n=46）。记录S组和N组在第1、2、3、4周以及第2、3、4、5、6个月时他克莫司的12小时血药浓度和剂量。同时，在两个组的每个时间间隔测定急性排斥反应发生率、肝肾功能检查结果以及可能相互作用的药物数量。术后第一个月每周比较他克莫司的剂量需求和血药浓度，第2至6个月每月比较一次。
两组在人口统计学特征、急性排斥反应发生率、肝肾功能检查结果或使用的可能相互作用的药物数量方面均无差异。S组在术后2周（2.8±0.4mg/d对3.6±0.7mg/d，P=0.006）、3周（2.9±0.7mg/d对3.9±0.8mg/d，P=0.008）、4周（2.9±0.8mg/d对3.9±1.0mg/d，P=0.023）和2个月（2.8±0.7mg/d对3.8±1.1mg/d，P=0.033）时他克莫司的剂量需求显著低于N组。除移植后2周外，两组他克莫司12小时谷浓度在其他时间均相似，移植后2周时S组受者的浓度显著高于N组受者（11.3±4.8ng/mL对7.0±3.8ng/mL，P=0.026）。
在AALDLT中，术后前2个月，SFS移植物受者的他克莫司剂量需求相比非SFS移植物受者显著降低。
