天津医药

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婴幼儿肝移植术后FK506的合理应用

孙晓叶,孙丽莹,朱志军,饶伟,蒋文涛,张建军,张雅敏,刘懿禾,沈中阳   

  1. 天津市第一中心医院
  • 收稿日期:2010-03-02 修回日期:2010-05-26 出版日期:2010-07-15 发布日期:2010-07-15
  • 通讯作者: 孙晓叶

Reasonable Application of FK506 after Liver Transplantation in Infants

  • Received:2010-03-02 Revised:2010-05-26 Published:2010-07-15 Online:2010-07-15

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摘要： 目的 探讨婴幼儿肝移植术后FK506的最佳应用剂量和最理想血药浓度。方法 2006年9月至2009年11月天津市第一中心医院东方器官移植中心行婴幼儿肝移植13例，其中亲体肝移植8例，劈离式肝移植5例。术中应用糖皮质激素，术后应用以FK506为基础的免疫抑制剂治疗。监测患儿肝移植术后3个月内、3个月至1年、1年以后FK506用量及血药浓度水平；FK506相关术后并发症情况。结果 随访3～40个月(中位数18个月)，患儿11例存活至今，2例死亡。术后3个月内、3个月至1年、1年以后FK506血药浓度分别为（8.64±3.71）ng?ml-1、（7.90±2.76）ng?ml-1、（5.38±1.73）ng?ml-1，FK506用量分别为（0.21±0.12）mg? kg-1?d-1、（0.18±0.08）mg? kg-1?d-1、（0.11±0.03）mg? kg-1?d-1。FK506相关术后并发症：急性排斥反应2例次，FK506相关精神症状3例次、感染12例次。结论 婴幼儿肝移植术后FK506浓度应维持于合适水平，根据FK506浓度调整用药剂量，这样才能最大限度减少FK506用量不足或过度引起的不良反应。

关键词: 肝移植, 婴幼儿, FK506

Abstract: Objective: To investigate the best application and the ideal blood concentration of FK506 after liver transplantation in infants. Methods: From September 2006 to November 2009,13 infants received liver transplantation in Center of East Organ Transplantation, First Central Hospital of Tianjin, including 8 living donor liver transplantations and 5 split liver transplantations. Corticosteroids were applied intra-operatively, and the FK506-based immunosuppressive therapy was used after the operation. The dosage and blood concentration of FK506 were monitored within 3 months, 3 months to 1 year, 1 year postoperatively, except for the FK506-related complications. Results: All of the patients were followed up 3 to 40 months (median 18 months), 11 cases of them were still alive, 2 cases died. The blood concentrations of FK506 within 3 months, 3 months to 1 year, 1 year after operation were （8.64±3.71）ng?ml-1,（7.90±2.76）ng?ml-1 and（5.38±1.73）ng?ml-1, while the dosages were (0.21 ± 0.12) mg ? kg-1 ? d-1, (0.18 ± 0.08) mg ? kg-1 ? d-1 and (0.11 ± 0.03) mg ? kg-1 ? d-1. The FK506-related complications postoperatively included acute rejection in 2 cases, infections in 12 man-times, FK506-related psychotic symptoms in three cases. Conclusion: The blood concentration of FK506 after liver transplantation in infants should be maintained at the appropriate level, and the dosage adjustments should be based on the concentration of FK506, so as to minimize the side effects of FK506 caused by insufficient or excessive amount.

Key words: Liver Transplantation, Infants, FK506