肾移植术后应用雷帕霉素转换方案的临床观察

目的：探讨肾移植术后患者应用雷帕霉素进行转换治疗的安全性和有效性。方法：分析2012-2016年北京朝阳医院泌尿外科肾移植术后由传统钙调磷酸酶抑制剂（CNI）为主的方案转换为雷帕霉素免疫抑制方案的患者。所有患者转换前均使用环孢素/他克莫司联合霉酚酸/硫唑嘌呤及糖皮质激素作为初始免疫抑制方案。各免疫抑制剂的剂量根据血药浓度进行调整，使用三联方案的患者在转换当天停用他克莫司/环孢素，雷帕霉素浓度控制在4~10 ng·mL^-1；使用四联方案的患者雷帕霉素浓度控制在3~7 ng·mL^-1，他克莫司剂量为原来的1/3，浓度控制在2~5 ng·mL^-1。分析患者转换前后1年血肌酐、蛋白尿、血常规和血生化指标；总结转换前后1年感染发生率和肿瘤患者转归。结果：33例患者转换1年后血肌酐水平下降，但结果差异无显著性（112.36±63.82）μmol·L^-1比（108.17±55.41）μmol·L^-1，P=0.58]。甘油三酯和低密度脂蛋白胆固醇在转换后1年有明显增长（P=0.04、0.02），转氨酶水平变化差异无显著性（P=0.19、0.12）。转换前后1年血小板、血红蛋白、血糖变化无明显差异。转换前后巨细胞病毒感染（CMV）、卡氏肺孢子菌肺炎（PCP）感染降低，肿瘤患者复发率降低，蛋白尿呈双向改变。结论：肾移植术后患者应用雷帕霉素转换方案是安全、有效的。

Clinical investigation on rapamycin conversion therapy after renal transplantation

OBJECTIVE To explore the safety and efficacy of rapamycin conversion therapy in patients after renal transplantation.METHODS Thirty three cases of urology in Beijing Chaoyang Hospital were selected to be converted into rapamycin immunosuppressive regimen for different reasons after renal transplantation.All patients were treated with cyclosporine/tacrolimus combined with mycophenolic acid/azathioprine and glucocorticoid as the initial immunosuppressive regimen.The dose of each immunosuppressive agent was adjusted according to the plasma concentration.Patients treated with triple regimen were stopped tacrolimus/cyclosporine on the day of conversion and the rapamycin concentration was controlled to be 4-10 ng·mL^-1.Patients with rapamycin concentration at 3-7 ng·mL^-1,tacrolimus dose reduced to 1/3 original,the concentration control at the 2-5 ng·mL^-1.Blood creatinine,proteinuria,blood and blood biochemical indexes were analyzed before and after conversion within 1 year.The incidence of infection and the outcome of tumor patients were summarized before and after conversion.RESULTS In 33 patients,the creatinine level decreased but not significantly(112.36±63.82) μmol·L^-1 vs.(108.17±55.41) μmol·L^-1,P=0.58].Triglyceride and low density lipoprotein cholesterol after the conversion for 1 year increased significantly (P=0.04,0.02).There was no significant difference in blood glucose,platelet and hemoglobin or liver function (P>0.05).Before and after conversion,CMV and PCP infections decreased,the recurrence rate of cancer patients decreased,proteinuria showed a two-way change.CONCLUSION The rapamycin conversion regimen in patients after renal transplantation is safe and effective.