南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (04): 538-543.doi: 10.12122/j.issn.1673-4254.2020.04.14

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免疫抑制剂在常染色体显性遗传性多囊肾患者肾移植术后的应用

李 琼，李江涛，杨 帆，刘燕娜，邓文锋，刘如敏，胡杨澄，夏仁飞，徐 健，苗 芸   

  • 出版日期:2020-04-30 发布日期:2020-04-20
  • 基金资助:

Application of immunosuppressants in patients with autosomal dominant polycystic kidney disease after kidney transplantation

  

  • Online:2020-04-30 Published:2020-04-20

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摘要： 目的 探究常染色体显性遗传性多囊肾（ADPKD）患者肾移植术后免疫抑制剂合理血药浓度。方法 收集2000年3月~2018年1月首次肾移植的68例ADPKD患者和68名性别、年龄和移植日期相匹配的其他肾移植受者(对照组）的临床资料，分析两组患者人、肾存活率、术后并发症以及术后1年内不同时期免疫抑制剂浓度的差异。同时根据术后是否发生泌尿道感染将ADPKD患者分为泌尿道感染组与非泌尿道感染组，分析两组患者术后1年内不同时期免疫抑制剂浓度的差异。结果 ADPKD组与对照组患者1、5、10年移植受者存活率分别为96.6%、94.1%、90.6%和96.0%、93.9%、93.9%；ADPKD组与对照组患者肾存活率分别为95.2%、90.8%、79.0%和96.0%、87.2%、82.3%，差异无统计学意义（P>0.05）。在术后急性排斥反应、胃肠道症状、心血管事件、肺部感染以及肿瘤的发生率上的差异无统计学意义（P>0.05）。术后9月，ADPKD组比对照组的他克莫司、霉酚酸血药谷浓度更低（P<0.05）；ADPKD组比对照组更容易发生泌尿道感染，且在ADPKD中泌尿道感染组较非泌尿道感染组的霉酚酸血药谷浓度要高（P<0.05）。结论 ADPKD患者移植术后长期维持需要的免疫抑制浓度可能要低于其他肾移植患者，且较高剂量的霉酚酸血药谷浓度与泌尿道感染的发生相关。

Abstract: Objective To investigate the optimal dose range of immunosuppressants in patients with autosomal dominant polycystic kidney disease (ADPKD) after renal transplantation. Methods A cohort of 68 patients with ADPKD who received their first renal transplantation between March, 2000 and January, 2018 in our institute were retrospectively analyzed, with 68 non-ADPKD renal transplant recipients matched for gender, age and date of transplant as the control group. We analyzed the differences in patient and renal survival rates, postoperative complications and concentrations of immunosuppressive agents between the two groups at different time points within 1 year after kidney transplantation. The concentrations of the immunosuppressants were also compared between the ADPKD patients with urinary tract infections (UTI) and those without UTI after the transplantation. Results The recipients with ADPKD and the control recipients showed no significantly difference in the overall 1- , 5- , and 10- year patient survival rates (96.6% vs 96.0% , 94.1% vs 93.9% , and 90.6% vs 93.9% , respectively; P>0.05), 1-, 5-, and 10-year graft survival rates (95.2% vs 96.0%, 90.8% vs 87.2%, and 79.0% vs 82.3%, respectively; P>0.05), or the incidences of other post- transplant complications including acute rejection, gastrointestinal symptoms, cardiovascular events, pneumonia, and neoplasms (P>0.05). The plasma concentrations of both tacrolimus and mycophenolate mofetil (MPA) in ADPKD group were significantly lower than those in the control group at 9 months after operation (P<0.05). The incidence of UTI was significantly higher in ADPKD patients than in the control group (P<0.05). In patients with ADPKD, those with UTI after transplantation had a significantly higher MPA plasma concentration (P<0.05). Conclusion In patients with ADPKD after renal transplant, a higher dose of MPA is associated with a increased risk of UTI, and their plasma concentrations of immunosuppressants for long-term maintenance of immunosuppression regimen can be lower than those in other kidney transplantation recipients.