Walker R G, d'Apice A J, Powell H R, Francis D M, McCredie D A, Kincaid-Smith P
Department of Nephrology, Royal Melbourne Hospital, Victoria, Australia.
Pediatr Nephrol. 1987 Oct;1(4):611-4. doi: 10.1007/BF00853598.
Since June 1985 ten consecutive paediatric cadaveric renal transplant recipients (aged from 7 to 15 years) have been studied prospectively to evaluate a triple immunosuppressive regime of low-dose cyclosporin A (CyA), azathioprine (AZA) and prednisolone (PNL) with the aim of eliminating PNL from the regime within 6 months. Follow-up has been over 6-18 months. Patient and graft survival are both 100%. Median (range) serum creatinine values at 6 months were 0.09 (0.05-0.14) mmol/l (n = 10) and 0.09 (0.06-0.16) mmol/l (n = 5) at 12 months. Readily reversible acute rejection episodes occurred in five patients (50%); two of these episodes occurred soon after cessation of PNL. Six months post-transplantation, PNL had been discontinued in six patients (60%). After 12 months, three of five patients were still not receiving PNL. Complications included hypertension (seven patients), cytomegaloviral infections (three patients), labial herpes simplex (one patient), leucopenia (two patients), marked hirsutism (four patients) and transient CyA nephrotoxicity (one patient). Following transplantation, all children had growth velocities greater than 5 cm/year and seven have growth patterns which suggest that "catch-up growth" may be occurring. This preliminary study shows that a triple immunosuppressive regime of low-dose CyA, AZA and PNL allows excellent patient survival, graft survival and graft function and has been associated with few complications, including a low incidence of CyA nephrotoxicity. Growth rates are very encouraging and in a high proportion of children it has been possible to discontinue PNL completely.
自1985年6月起，对连续10例儿科尸体肾移植受者（年龄7至15岁）进行了前瞻性研究，以评估低剂量环孢素A（CyA）、硫唑嘌呤（AZA）和泼尼松龙（PNL）的三联免疫抑制方案，目标是在6个月内从该方案中停用PNL。随访时间为6至18个月。患者和移植物存活率均为100%。6个月时血清肌酐值中位数（范围）为0.09（0.05 - 0.14）mmol/l（n = 10），12个月时为0.09（0.06 - 0.16）mmol/l（n = 5）。5例患者（50%）发生了易于逆转的急性排斥反应；其中2例在停用PNL后不久发生。移植后6个月，6例患者（60%）已停用PNL。12个月后，5例患者中有3例仍未接受PNL。并发症包括高血压（7例患者）、巨细胞病毒感染（3例患者）、唇单纯疱疹（1例患者）、白细胞减少（2例患者）、明显多毛症（4例患者）和短暂性CyA肾毒性（1例患者）。移植后，所有儿童的生长速度均大于5厘米/年，7例儿童的生长模式表明可能正在发生“追赶生长”。这项初步研究表明，低剂量CyA、AZA和PNL的三联免疫抑制方案可实现出色的患者存活、移植物存活和移植物功能，且并发症较少，包括CyA肾毒性发生率较低。生长速度非常令人鼓舞，并且在很大比例的儿童中已完全停用PNL成为可能。
