心脏死亡器官捐献肾移植术后肾功能延迟恢复的免疫抑制剂选择

摘要

公民死亡器官捐献正在成为我国器官移植供体的主要来源.虽然有研究表明心脏死亡器官捐献(donation after cardiac death,DCD)来源肾移植的长期预后和脑死亡器官捐献(donation after brain death,DBD)肾移植的长期预后相近,但相比DBD移植,DCD来源肾移植的移植物功能延迟恢复(delayed graft function,DGF)发生率增加.目前临床广泛应用诱导治疗应对DGF.维持治疗通常是给予钙调神经磷酸酶抑制剂延迟给药或减量方案,同时加强其他免疫抑制剂,如麦考酚酸(mycophenolic acid,MPA)类药物.同时需要注意的是,DGF的状态下,MPA类药物浓度-时间曲线下面积(area under concenration-time curve,AUC)受到抑制,因此,在合并DGF的DCD肾移植受者中,MPA类药物的剂量更难以把握,需要加强MPA类药物浓度监测.%Donation after cardiac death (DCD) is becoming the main source of organ transplantation in China.DCD has increased the incidence of delayed graft function (DGF) when compared with donation after brain death (DBD) in renal transplantation,though previous studies revealed they both have identical long term outcome of grafts.Currently,induction therapy is widely used for preventing DGF.In order to prevent grafts' function,the subsequent maintenance regimens usually include delayed and reduced calcineurin inhibitor (CNI) with strengthened other immunosuppressant,such as mycophenolic acid (MPA).And it should be noticed that,the area under concenration-time curve (AUC) of MPAs is lower when DGF developed.Therefore,the dosage of MPAs in DCD recipients with DGF is more difficult to grasp and therapeutic drug monitoring of MPAs is nessesary in those patients.