Dhawan A, Tredger J M, North-Lewis P J, Gonde C E, Mowat A P, Heaton N J
Paediatric Liver Services King's College Hospital, London, UK.
Transpl Int. 1997;10(4):331-4. doi: 10.1007/s001470050066.
We report the use of fluconazole to control primary immunosuppressive management with tacrolimus in a 9-year-old liver transplant recipient. Progressive increases in the doses of both cyclosporin (up to 20 mg/kg/day) and, subsequently, tacrolimus (up to 60 mg/day) failed to maintain immunosuppressive levels of both agents. After excluding poor compliance, drug interactions and analytical problems and identifying poor bioavailability (< 2.6%) and rapid clearance (4.2 l/h), fluconazole (100 mg/day) was initiated to inhibit tacrolimus metabolism and consistent therapeutic blood levels of tacrolimus were achieved. However, graft function had deteriorated irrevocably and retransplantation was performed. Simultaneous use of tacrolimus (5 mg/day) and fluconazole (100 mg/day) maintained immunosuppression after transplantation. Three weeks later, obstruction of the Roux loop caused deteriorating liver function and tacrolimus blood levels fell. After correction at laparotomy, stabilisation was achieved and discharge was possible on 5 mg tacrolimus b.i.d. plus fluconazole (100 mg).
我们报告了在一名9岁肝移植受者中使用氟康唑来控制他克莫司的初始免疫抑制治疗。环孢素剂量逐渐增加（高达20mg/kg/天），随后他克莫司剂量也逐渐增加（高达60mg/天），但仍无法维持两种药物的免疫抑制水平。在排除依从性差、药物相互作用和分析问题，并确定生物利用度低（<2.6%）和清除率快（4.2l/h）后，开始使用氟康唑（100mg/天）以抑制他克莫司代谢，并实现了他克莫司稳定的治疗血药浓度。然而，移植肝功能已不可逆转地恶化，遂进行了再次移植。移植后同时使用他克莫司（5mg/天）和氟康唑（100mg/天）维持免疫抑制。三周后，Roux袢梗阻导致肝功能恶化，他克莫司血药浓度下降。剖腹手术矫正后，病情稳定，他克莫司5mg每日两次加氟康唑（100mg）时患者得以出院。
