Herget S, Heemann U, Friedrich J, Kribben A, Wagner K, Philipp T
Department of Nephrology, University Hospital, Essen, Germany.
Clin Nephrol. 1996 May;45(5):352-4.
Follow-up of 9 renal transplant recipients who were converted from cyclosporin A to tacrolimus (FK506) as recue therapy for intractable rejection is described. All patients initially received a cyclosporin A based immunosuppression. They developed biopsy proven acute rejections 22 +/- 11 days after transplantation which did not resolve by i.v. steroids and subsequent OKT3. Fifty-three +/- 11 days post transplantation the patients were converted from cyclosporin A to tacrolimus. After conversion to tacrolimus 6 patients developed a stabile transplant function. One transplant recipient who initially responded to tacrolimus lost his graft due to a chronic rejection 9 months following conversion. Two patients with never functioning kidneys remained on dialysis despite tacrolimus therapy. After conversion no serious adverse events occurred and only a slightly increased infection rate and hyperglycemia were noted as major side effects of tacrolimus. Tacrolimus rescue therapy was effective in treating acute renal allograft rejection unresponsive to steroids and OKT3. Tacrolimus rescue therapy was not accompanied by a substantial rise in complications. Patients with never functioning kidneys did not seem to benefit from tacrolimus rescue therapy.
描述了9例肾移植受者从环孢素A转换为他克莫司（FK506）作为难治性排斥反应挽救治疗的随访情况。所有患者最初均接受基于环孢素A的免疫抑制治疗。他们在移植后22±11天出现经活检证实的急性排斥反应，静脉注射类固醇及随后使用OKT3治疗均未缓解。移植后53±11天，患者从环孢素A转换为他克莫司。转换为他克莫司后，6例患者移植功能稳定。1例最初对他克莫司有反应的移植受者在转换治疗9个月后因慢性排斥反应失去了移植物。2例移植肾从未发挥功能的患者尽管接受了他克莫司治疗仍需透析。转换治疗后未发生严重不良事件，仅感染率略有增加和高血糖被视为他克莫司的主要副作用。他克莫司挽救治疗在治疗对类固醇及OKT3无反应的急性肾移植排斥反应方面有效。他克莫司挽救治疗并未伴随并发症大幅增加。移植肾从未发挥功能的患者似乎未从他克莫司挽救治疗中获益。
