信州大学医学部附属病院及び長野赤十字病院における腎移植免疫抑制プロトコールの実際と今後の展望

概要

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Eighteen renal transplantations were performed at Shinshu University Hospital as of September 1999. Recently the new immunosuppressive drugs tacrolimus and MMF (Mycophenol mofetil)have been placed on the market. We re evaluated the past and potent immunosuppressive protocol for renal transplantation established in 1998 at Shinshu University Hospital and proposed a new protocol. In the past protocol, induction of immunosuppressive therapy was carried out using tacrolimusq% CsA (cyclosporine A) and PSL (prednisolone), with AZ (azathioprine) q% CP (cyclophosphamide) or ALG (antihuman lymphocyte globulin).For high risk groups,AZ was added. In ABO incompatible living-related cases, double filtration plasmapheresis was performed before CsA, PSL, CP, and ALG administration. In our new protocol, we decided to try the tacrolimus-based protocol first. If adverse effects of tacrolimus appeare, conversion to the CsA-based protocol,which is almost the same as that established in 1999,will be considered. To treat patients with acute rejection,we choose an intravenous steroid therapy followed by mini recycle or deoxysupergualine therapy, if necessary. The final aim of introducing the new immunosuppressive protocol for renal transplantation is to achieve improvement of long-term graft and patient survival by prevention of acute or chronic rejection.MMF may play an important role in achieving this goal in the future.
信州医学会の論文
2000-06-10