Williams R, Blackburn A, Neuberger J, Calne R Y
Q J Med. 1985 Dec;57(224):897-905.
The clinical course of 29 liver graft recipients in the Cambridge/King's College Hospital series who have received cyclosporin A (CyA) for up to five years (median 40 months) was analysed with particular reference to the immunosuppressive effectiveness and adverse effects of the drug. Eight patients had been maintained on prednisolone and azathioprine for two to six years before treatment was changed to cyclosporin A and the remainder were started on cyclosporin A after operation. Results in both groups over a one to five year study period are similar, and showed that cyclosporin A was effective in maintaining adequate immunosuppression, allowing complete withdrawal of prednisolone in 16 patients. Episodes of rejection were observed in only three patients and in two of these it was of the chronic 'vanishing bile duct' variety. Some evidence of nephrotoxicity (serum creatinine greater than 150 mumol/l) occurred in 72 per cent (21 of 29 patients) but it was necessary to discontinue treatment in only two. Hypertension, occasionally of sudden onset, was found in nine patients and led to the withdrawal of the drug in two. Additional hypotensive drug treatment was required in five. In one other patient cyclosporin A was discontinued on account of severe headaches. Cyclosporin A was withdrawn in two further patients. Withdrawal led to considerable risk of acute rejection and increased doses of corticosteroids as well as substitution of azathioprine were required at that time.
对剑桥/国王学院医院系列中29例接受环孢素A（CyA）治疗长达5年（中位时间40个月）的肝移植受者的临床病程进行了分析，特别关注了该药物的免疫抑制效果和不良反应。8例患者在改用环孢素A之前已接受泼尼松龙和硫唑嘌呤治疗2至6年，其余患者在术后开始使用环孢素A。在1至5年的研究期内，两组的结果相似，表明环孢素A在维持足够的免疫抑制方面有效，16例患者得以完全停用泼尼松龙。仅3例患者观察到排斥反应发作，其中2例为慢性“消失性胆管”类型。72%（29例患者中的21例）出现了一些肾毒性证据（血清肌酐大于150μmol/L），但仅2例需要停药。9例患者出现高血压，偶尔为突然发作，2例因此停药。5例需要额外的降压药物治疗。另有1例患者因严重头痛停用环孢素A。另有2例患者停用环孢素A。停药导致急性排斥反应的风险显著增加，当时需要增加皮质类固醇剂量并改用硫唑嘌呤。
