Matas A J, Tellis V A, Quinn T, Soberman R, Veith F J
Transplant Proc. 1986 Apr;18(2 Suppl 1):141-50.
CsA immunosuppression has resulted in decreased graft loss from rejection. However, rejection episodes do occur and, in fact, rejection remains as the major cause of graft loss in the CsA-treated patient. CsA, itself, has added to the differential diagnosis of renal dysfunction following transplantation. In the majority of circumstances, rejection can be differentiated from CsA nephrotoxicity as well as other causes of renal dysfunction by a combination of clinical presentation, renal scan and sonography, CsA levels, and percutaneous allograft biopsy. In some circumstances, a therapeutic trial of lowering the CsA dose may be indicated before extensive laboratory study. Most acute rejection episodes will respond to increased steroid doses. In patients with low CsA levels, increasing the CsA dose may be advised. Steroid-resistant rejection frequently responds to ALG. Patients with repeated episodes of renal dysfunction may be stabilized by using the combination of prednisone, azathioprine, and CsA.
环孢素A免疫抑制已使因排斥反应导致的移植物丢失减少。然而，排斥反应仍会发生，事实上，排斥反应仍是接受环孢素A治疗患者移植物丢失的主要原因。环孢素A本身增加了移植后肾功能不全的鉴别诊断难度。在大多数情况下，通过临床表现、肾脏扫描及超声检查、环孢素A血药浓度以及移植肾穿刺活检等综合手段，可将排斥反应与环孢素A肾毒性以及其他导致肾功能不全的原因区分开来。在某些情况下，在进行广泛的实验室检查之前，可能需要进行降低环孢素A剂量的治疗性试验。大多数急性排斥反应可通过增加类固醇剂量得到缓解。对于环孢素A血药浓度较低的患者，建议增加环孢素A剂量。对类固醇耐药的排斥反应通常对抗淋巴细胞球蛋白有效。反复出现肾功能不全的患者可通过联合使用泼尼松、硫唑嘌呤和环孢素A实现病情稳定。
