摘要
目的观察肾移植后发生尿路上皮肿瘤的患者使用西罗莫司（SRL）联合低剂量钙凋磷酸酶抑制剂（CNI）免疫抑制方案的有效性和安全性。方法对15例肾移植后发生尿路上皮肿瘤的患者调整免疫抑制方案，采用SRI。替代霉酚酸酯（或硫唑嘌呤）。SRL的初始负荷剂量为2mg，次日剂量为1mg，之后根据SRL血药浓度调整维持剂量，使血药浓度维持在4～6μg／L；在其血药浓度稳定后将CNI减少至原用量的1／3。全部肿瘤患者均行手术治疗并辅以局部灌注化疗。转换SRL期间观察患者肿瘤的复发情况、移植肾功能及不良反应。结果对15例患者随访2年中，9例肿瘤无复发；6例复发，其中2例复发2次，4例复发1次。在复发的患者中，4例肿瘤病理分级较转换SRL前降低，2例与转换前相同。所有复发的患者均再次行手术治疗。所有患者在使用SRL期间均未出现急性排斥反应，且其中11例患者肾功能指标较治疗前下降，4例肾功能保持稳定。转换治疗过程中出现高脂血症12例，不明原因发热4例，血小板减少3例，关节疼痛2例，所有不良反应经对症治疗后症状均有所好转。结论肾移植后发生尿路上皮肿瘤的患者使用SRL联合低剂量CNI的免疫抑制方案是安全和有效的。
Objective To evaluate the efficacy and safety of sirolimus combined with low dose calcineurin inhibitor to treat 15 renal allograft recipients with urothelial carcinoma. Methods The immunosuppressive regimen was modulated in 15 reeepients. MMF or Aza was replaced with sirolinms. The loading dose was 2 mg/d and the next dose was I rng/d. The sirolimus dosage was adjusted according to the blood level and the sustained blood level was 4~6 μg/L. In all the 15 cases the calcineurin inhibitor was reduced to one third of the original dosage after the sirolimus blood level was sta ble. Surgical treatment and intravesical instillation chemotherapy were carried out in all cases. During the treatment, the recurrence of the tumor, the allograft function and adverse effect were observed. Results Of the 15 cases, 9 cases had no tumor recurrence within 2 years. Two cases had tumor recur- rences twice and 4 cases once. Among the recurrent cases, the tumors pathology grade in 4 cases was degraded and 2 cases were identical after conversion. All recurrent patients had been treated with sur gery again. There was no acute rejection observed during sirolimus treatment. The graft function of 11 cases was improved with a decrease of creatinine and 4 cases kept stabilization. There was hyperlipoi demia in 12 cases, unknown fever in 4 cases, thrombocytopenia in 3 cases and arthralgia in 2 cases during conversion. All the adverse events were improved after treatment. Conclusion Among the renal allograft recipients with urothelial carcinoma, combined with low dose calcineurin inhibitor is an effective and safe treatment regimen.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2008年第10期620-622,共3页
Chinese Journal of Organ Transplantation
关键词
肾移植
泌尿系肿瘤
西罗莫司
Kidney transplantation
Urologic neoplasms
Sirolimus
