Yasumura T, Ohmori Y, Aikawa I, Fukuda M, Suzuki S, Nakai I, Matsui S, Oka T
Jpn J Surg. 1986 May;16(3):181-8. doi: 10.1007/BF02471091.
Long-term clinical aspects after kidney transplantation using cyclosporine (CsA) were studied in 33 patients who received kidney grafts from one haplotype identical living related donor and who were followed for at least one year. Both actual graft and patient survival rates were 97 per cent at one year. Incidence and severity of acute rejection were reduced to a greater extent in patients treated with CsA than in patients treated with azathioprine (AZ). The incidence of infections was low, and no serious bacterial infection occurred in these 33 patients. In 17 of 33 patients with a deteriorative graft function caused by intractable nephrotoxicity, CsA was converted to AZ. The mean serum creatinine level of converted patients was significantly higher than that of patients maintained with CsA at each time when a dose of CsA was stepwise reduced from 14 mg/kg/day to 6 mg/kg/day. Conversion to AZ improved graft function dramatically, although it resulted in reversible acute rejections in 4 patients. CsA induced hepatotoxicity occurred in 10 patients, but in all normal liver function was restored with decrease in the dose. The potent immunosuppressive effect of CsA compensates for its side effects. However, CsA should be converted to AZ when the chronic nephrotoxicity persists at a late stage of post-transplantation.
对33例接受来自单倍型相同的活体亲属供者肾脏移植且随访至少一年的患者，研究了使用环孢素（CsA）进行肾脏移植后的长期临床情况。移植肾和患者的1年实际存活率均为97%。与接受硫唑嘌呤（AZ）治疗的患者相比，接受CsA治疗的患者急性排斥反应的发生率和严重程度降低得更多。感染发生率较低，这33例患者中未发生严重细菌感染。在33例因难治性肾毒性导致移植肾功能恶化的患者中，有17例将CsA转换为AZ。当CsA剂量从14mg/kg/天逐步降至6mg/kg/天时，每次转换患者的平均血清肌酐水平均显著高于继续使用CsA的患者。转换为AZ后移植肾功能显著改善，尽管有4例患者出现了可逆性急性排斥反应。10例患者发生了CsA诱导的肝毒性，但所有患者肝功能均随着剂量降低而恢复正常。CsA强大的免疫抑制作用弥补了其副作用。然而，当移植后期慢性肾毒性持续存在时，应将CsA转换为AZ。
