摘要
目的 探讨肾移植术后发生泌尿系统肿瘤的患者采用西罗莫司（SRL）替代钙调磷酸酶抑制剂（CNI）的有效性及安全性。方法 将9例肾移植术后发生泌尿系统肿瘤患者的CNI转换为SRL。所有患者停用CNI 12h后使用SRL，首次负荷剂量为3～4mg，维持剂量为0．5～1．5mg／d，以后根据SRL的血药浓度调整使用剂量。将SRL的血药浓度维持于：术后1年内6～10μg／L，1～2年4～8μg／L，2年以后3～6μg／L。药物转换过程中，监测患者的肿瘤复发情况，观察移植肾功能及排斥反应，统计药物的不良反应及药物转换前、后治疗费用的变化。结果 9例患者经药物转换后有8例病情稳定，肿瘤复发率明显降低。仅有1例患者肿瘤复发，于药物转换后12个月死亡。所有患者肾功能保持稳定并有所改善，均无明显不良反应发生，治疗费用也较药物转换前有不同程度的下降。结论 肾移植后发生泌尿系统肿瘤的患者使用SRL是安全和有效的，同时也可减少治疗费用。
Objective To evaluate the efficacy and safety of conversion from calcineurin Inhibitor （CNI） to sirolimus （SRL） treatment among 9 post-renal transplant recipients with urological neoplasm. Methods Conversion to SRL treatment was performed with sharp withdrawal of CNI. The patients were administered with SRL 12 h after CNI withdrawal. The first dose was 3-4 mg/day and the sustained dose was 0. 5-1.5 mg/day. The SRL dosage was adjusted according to the blood level and the sustained blood level was 6-10μg/L in the first year after operation, 4-8μg/L in the second year and 3-6μg/L after 2 years. During the SRL conversion treatment, the recurrence of the tumor was monitored. Also the renal function and the reiection, the adverse effects and the cost before and after conversion treatment were observed. Results All patients enrolled in the study completed 12 months observation. Eight patients had no tumor recurrence and acute rejection or major infection after SRL conversion treatment. One patient died due to tumor recurrence 12 months after transplantation, The renal functions of 8 patients were improved with a significantly decrease of creatinine. No significant adverse effects were found during the observation. The medicine cost after SRL conversion treatment was decreased as compared with that before the conversion treatment. Conclusions Among the renal transplant recipients with urological neoplasm, conversion to SRL treatment with sharp withdrawal of the CNI is an effective and safe alternative therapy. It can avoid the major infections, acute rejection, and significant side effects. Decreasing the recurrence and improving the renal function in 1 year can be observed in the study, but the efficacy and safety in long-term need to be confirmed in the future.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2007年第4期205-207,共3页
Chinese Journal of Organ Transplantation
关键词
免疫抑制剂
肾移植
泌尿系肿瘤
Immunosuppressive agents
Kidney transplantation
Urologic neoplasms
