【摘要】 目的 观察肾移植术后应用环孢素A(CsA)导致肝功能损害的患者，更换普乐可复(FK506)对肝功能损害治疗的有效性和安全性。方法 选择18例肾移植术后应用CsA出现肝功能异常的患者，以FK506替换CsA，FK506初始剂量及维持剂量以患者体重、移植后时间、病情及FK506血药浓度进行相应调整，同时保肝治疗。结果 将CsA替换成FK506治疗2～8周后，患者肝功能指标(血清ALT、D-BIL及I-BIL)呈明显下降趋势。8～12周后，14例患者肝功能恢复正常，4例接近正常，替换前后比较差异有显著性，P<0.05。肾功能(血清Cr、BUN)换药前后比较差异无显著性，P>0.05。继续随访3～6个月,肝功能、肾功能全部维持正常。结论 对CsA引起肝功能损害的肾移植患者应用FK506替换治疗是安全有效的。

    【关键词】 肾移植； 肝功能损害； 环孢素A； 普乐可复

    Clinical study on the reversional effect of FK506 in renal allograft recipients with hepatic dysfunction resulted from CsAHUANG Shi-ming,LI Shun,ZHAO Qing-li,et al.

    Department of Urological Surgery,Qianfoshan Hospital of Shandong Province,Jinan 250014,China

    【Abstract】 Objective To evaluate the therapeutic efficacy and safety of FK506 for kidney transplantation patients with hepatic dysfunction resulted from CsA.Methods Eighteen patients after kidney transplantation with hepatic dysfunction resulted from CsA were studied. FK506 was used in substitution of CsA as a therapeutic method,the initial dose and maintaining dose of FK506 was only used in accordance with body weight postoperative period of the patients’ condition.Therapy for protecting liver was administrated during this period.Results Administration of FK506 in substitution of CsA resulted in markedly reduced blood indices (ALT,D-BIL and I-BIL) from 2 to 8 weeks. Liver function of 14 patients returned normal in 8 to 12 weeks. And that of 4 patients become nearly normal. The difference between before and after conversion was significant (P<0.05).The difference in renal function (serum Cr and BUN)between before and after conversion was not significant (P<0.05). Following up 3～6 months, it was found that liver function and renal function of all patients were normal.Conclusion It is effective and safe to substitute CsA by FK506 in kidney transplantation recipients with hepatic dysfunction resulted from CsA. ......