Abstract:

BACKGROUND: Different degrees of immunoreaction are stimulated in different isolated organ transplantation. Thus, the kind and the dose of immunosuppressive agent in different isolated organ transplantation patients are distinguishing. The application of immunosuppressive agent in combined organ transplantation is more complicated, which is one of the experiences that the transplant doctor should master.
OBJECTIVE: To explore the suitable immunosuppressive project in combined liver and kidney transplantation (CLKT) patients.
METHODS: A total of 10 patients underwent CLKT from the Organ Transplantation Center, the 309 Hospital of Chinese PLA from April 2002 to July 2009. The control groups were comprised of isolated liver transplantation (ILT) patients and isolated kidney transplantation (IKT) patients. The immunosuppressive project, which was based on tacrolimus, was adopted in the early postoperative period in these three groups. Basiliximab was used as immune inducer in these all cases. In the CLKT and ILT patients, 500 mg methyllprednisolone was used during the operation, then 160 mg in the first day after the operation. The administration was performed twice. The dose of methyllprednisolone was decreased 40 mg per day in the following days. 20 mg prednisone was given from the day 5 and the hormone was withdrawn by the end of the second month. Mycophenolate was also withdrawn in the end of the sixth month and tacrolimus was used only from then on. In the IKT patients, 1 000 mg methyllprednisolone was used during the operation, followed by 500 mg/d in the first three days after the operation. Prednisone was decreased from 50 mg/d to 10 mg/d gradually. Tacrolimus, mycophenolate and prednisone were all used perennially in IKT patients.
RESULTS AND CONCLUSION: The dose of tacrolimus to patients undergoing CLKT in early period and sixth month was similar to patients undergoing ILT (P > 0.05), and was obviously lower than patients undergoing IKT (P < 0.05 and P < 0.01). Mycophenolate and prednisone to CLKT and ILT patients were both withdrawn in the first six months, the doses of which were obviously lower than to IKT patients. Mycophenolate and prednisone were used perennially in IKT patients. Individual difference for drug displayed in some patients of these three groups since 1 year after operation. There was no long-term hepatic insufficiency in the CLKT patients. Low-dose immunosuppressive agent has little effect on the patient’s immune system, so it brought lower infection rate. A satisfactory therapeutic efficacy to CLKT patients has been got when the immunosuppressive project of ILT patients was used. Mycophenolate and prednisone were withdrawn in the first six months. The dose of tacrolimus was lower than IKT patients.