Agarwal S K, Dash S C, Tiwari S C, Saxena S, Mehta S, Guleria S, Dwivedi S N, Mehra N K
Department of Nephrology, All India Institute of Medical Sciences Ansari Nagar, New Delhi.
Transplantation. 1995 Jan 15;59(1):27-31. doi: 10.1097/00007890-199501150-00006.
Results of 34 recipients of living related renal allografts initially treated with cyclosporine, azathioprine, and prednisolone and later electively converted to AZA and PRED are presented. Thirteen (group A), 14 (group B), and 7 (group C) patients were converted before 9 months, between 9 and 12 months, and after 12 months, respectively. Thirty-four patients who were on AZA and PRED and had never received CsA served as controls. Of the 34 patients, 33 were HLA haploidentical with their donors and 1 was HLA identical. All patients received a mean 8.62 +/- 7.39 third-party blood transfusions. In the control group, 29 patients received haploidentical grafts. The number of blood transfusions given to this group was 7.09 +/- 9.13. Of the 34 patients receiving triple-drug therapy, 9 (26%) had acute rejection within 3 months after conversion, as compared with 5 (14.7%) in the control group (P > 0.05). Although 1 case had acute rejection before conversion, all recipients had stable graft function at the time of conversion. Of these 9 recipients, 7 had conversion over 4-7 weeks, while 2 had rapid conversion. Following treatment of the rejection episodes, 4 patients in the study group responded to therapy, as compared with 3 cases in the control group (P > 0.05). After a mean follow-up of 18.62 +/- 10.31 months (range 3-41 months) following conversion, 4 patients were normal, 4 had chronic rejection (mean serum creatinine = 3.0 mg/100 ml), and 1 was back on regular dialysis. Eventually, of the 34 patients who were converted from triple-drug to double-drug therapy, 25 were normal, 5 had stable chronic rejection, 2 were back on regular dialysis, 1 was retransplanted, and 1 died due to failed graft. At the end of follow-up, graft survival in the study group was 88.2%, as compared with 85.5% in controls (P > 0.05). We conclude that conversion from triple-drug to double-drug therapy is not without risk, even in living related primary renal transplantation. Degree of HLA matching, number of pretransplant blood transfusions, and rejection before conversion did not have any significant effect on rejections following conversion, and the graft loss following conversion is unpredictable.
本文呈现了34例亲属活体肾移植受者的结果，这些受者最初接受环孢素、硫唑嘌呤和泼尼松龙治疗，随后选择性地转换为硫唑嘌呤和泼尼松治疗。分别有13例（A组）、14例（B组）和7例（C组）患者在9个月前、9至12个月之间以及12个月后进行了转换。34例接受硫唑嘌呤和泼尼松治疗且从未接受过环孢素治疗的患者作为对照组。34例患者中，33例与其供者HLA单倍型相同，1例HLA完全相同。所有患者平均接受了8.62±7.39次第三方输血。对照组中，29例患者接受了单倍型相同的移植物，该组输血次数为7.09±9.13次。34例接受三联药物治疗的患者中，9例（26%）在转换治疗后3个月内发生急性排斥反应，而对照组为5例（14.7%）（P>0.05）。虽然有1例患者在转换治疗前发生急性排斥反应，但所有受者在转换治疗时移植物功能稳定。在这9例受者中，7例在4至7周内完成转换，2例为快速转换。在治疗排斥反应发作后，研究组有4例患者对治疗有反应，而对照组为3例（P>0.05）。在转换治疗后平均随访18.62±10.31个月（范围3至41个月）后，4例患者情况正常，4例发生慢性排斥反应（平均血清肌酐=3.0mg/100ml），1例重新接受规律透析。最终，34例从三联药物治疗转换为双联药物治疗的患者中，25例情况正常，5例慢性排斥反应稳定，2例重新接受规律透析，1例再次移植，1例因移植物功能衰竭死亡。随访结束时，研究组的移植物存活率为88.2%，对照组为85.5%（P>0.05）。我们得出结论，即使在亲属活体初次肾移植中，从三联药物治疗转换为双联药物治疗也并非没有风险。HLA匹配程度、移植前输血次数以及转换治疗前的排斥反应对转换治疗后的排斥反应没有显著影响，且转换治疗后的移植物丢失情况不可预测。
