Roth D, Colona J, Burke G W, Ciancio G, Esquenazi V, Miller J
Department of Medicine, University of Miami School of Medicine and Miami Veterans Administration Hospital, Florida 33101, USA.
Transplantation. 1998 Jan 27;65(2):248-52. doi: 10.1097/00007890-199801270-00018.
Studies using tacrolimus and corticosteroids or the combination of cyclosporine, mycophenolate mofetil, and corticosteroids have been shown to reduce the incidence of biopsy-proven acute rejection episodes in cadaveric kidney recipients compared with cyclosporine-based immunosuppression. The current study is a retrospective analysis of our experience with tacrolimus combined with mycophenolate mofetil and steroids as primary immunosuppression for kidney transplant recipients.
In a retrospective analysis, 72 patients who received primary therapy with tacrolimus, mycophenolate mofetil, and corticosteroids (triple therapy) were compared with a control group of 98 kidney recipients who received tacrolimus and corticosteroids (double therapy).
There was a significant reduction in the incidence of biopsy-confirmed acute rejection in the triple therapy group (8.2%) compared with the double therapy group (21%; P=0.003). One-year patient and graft survival did not differ between groups. The incidence of posttransplant diabetes mellitus was 18% and 21% in the triple and double therapy groups, respectively. Leukopenia and gastrointestinal side effects were the most common cause for discontinuation of mycophenolate mofetil.
The combination of tacrolimus with mycophenolate mofetil and corticosteroids is more effective at preventing early acute rejection than tacrolimus and corticosteroids alone. The use of mycophenolate mofetil was associated with a higher incidence of leukopenia and diarrhea, often leading to discontinuation of the drug.
与基于环孢素的免疫抑制相比，使用他克莫司和皮质类固醇或环孢素、霉酚酸酯和皮质类固醇联合治疗的研究已表明可降低尸体肾移植受者经活检证实的急性排斥反应的发生率。本研究是对我们使用他克莫司联合霉酚酸酯和类固醇作为肾移植受者初始免疫抑制治疗经验的回顾性分析。
在一项回顾性分析中，将72例接受他克莫司、霉酚酸酯和皮质类固醇初始治疗（三联疗法）的患者与98例接受他克莫司和皮质类固醇治疗（双联疗法）的肾移植受者对照组进行比较。
与双联疗法组（21%）相比，三联疗法组活检证实的急性排斥反应发生率显著降低（8.2%；P=0.003）。两组间1年的患者和移植物存活率无差异。三联疗法组和双联疗法组移植后糖尿病的发生率分别为18%和21%。白细胞减少和胃肠道副作用是停用霉酚酸酯最常见的原因。
与单独使用他克莫司和皮质类固醇相比，他克莫司联合霉酚酸酯和皮质类固醇在预防早期急性排斥反应方面更有效。使用霉酚酸酯与白细胞减少和腹泻的发生率较高相关，常导致停药。
