Nunoda Shinichi, Suwa Kuniaki, Shitakura Kazunobu, Kikuchi Tomoko, Nakajima Shun, Hattammaru Miwa, Mitsuhashi Tetsuya, Okajima Kiyotaka, Kubo Yutaka, Otsuka Kuniaki
Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
J Cardiol Cases. 2012 May 14;6(1):e26-e29. doi: 10.1016/j.jccase.2012.04.003. eCollection 2012 Jul.
We report on a 25-year-old female heart transplant patient who presented with recurrent episodes of cellular rejection due to decreased adherence to immunosuppressive therapy. She received a heart transplantation in 1994 when she was 10 years old. In order to improve her adherence to immunosuppressive therapy, switching to the once-daily extended-release formulation of tacrolimus was performed in a step-wise fashion. First, the twice-daily formulation of cyclosporin A was replaced with the twice-daily preparation of tacrolimus. When the trough blood levels of tacrolimus reached a plateau in the range of 5.0 ng/mL, it was changed to the once-daily extended-release formulation of tacrolimus after confirming the absence of new rejection episodes. There were no significant changes in renal function before and after the switch. After being discharged from the hospital, the patient made significant advancements in adherence to immunosuppressive therapy. Her subsequent clinical course was uneventful, with no adverse events observed. Most patients who undergo solid organ transplantation must receive lifelong immunosuppressive therapy. This case demonstrates that conversion to the extended-release formulation of tacrolimus from other calcineurin inhibitor preparations is a reasonable choice to consider in the management of compromised immunosuppressive therapy adherence in heart transplant patients during the late posttransplant period.
我们报告了一名25岁的女性心脏移植患者，该患者因免疫抑制治疗依从性降低而出现反复的细胞排斥反应。她在1994年10岁时接受了心脏移植。为了提高她对免疫抑制治疗的依从性，逐步换用了每日一次的他克莫司缓释制剂。首先，将每日两次的环孢素A制剂换成每日两次的他克莫司制剂。当他克莫司的谷血浓度达到5.0 ng/mL的稳定水平，且确认无新的排斥反应发作后，将其换成每日一次的他克莫司缓释制剂。换药前后肾功能无显著变化。出院后，患者在免疫抑制治疗的依从性方面有了显著改善。其随后的临床过程平稳，未观察到不良事件。大多数接受实体器官移植的患者必须接受终身免疫抑制治疗。本病例表明，在心脏移植患者移植后期免疫抑制治疗依从性不佳的管理中，从其他钙调神经磷酸酶抑制剂制剂转换为他克莫司缓释制剂是一个值得考虑的合理选择。
