Calcineurin inhibitor投与法に苦慮した生体腎移植の１例 :ミコフェノール酸モフェチル併用の有用性

概要

論文の詳細を見る
A 19-year-old woman received an ABO-compatible living-related renal transplant whose donor was her　46-year-old mother (HLA A, B 2 match, DR 2 match), on December 9, 1999. The etiology of the patient's native kidney disease was diagnosed as chronic glomerulonephritis (sclerosing glomerulonephritis) based on　renal biopsy. The induction therapy included tacrolimus(FK) and prednisolone. The first graft biopsy on the　27th postoperative day revealed FK-associated nephropathy(microangiopathy) because of unstable blood FK.　After lowering FK blood concentration, the serum creatinine (SCr) level soon decreased from 1.2mg/dl to 0.7mg/dl.On the 40th　postoperative day she developed hyperglycemia,which improved soon after the conversion of tacrolimus to cyclosporin A (CsA). The blood CsA trough level was maintained at about 100ng/ml; however, the SCr level increased up to 0.97mg/dl in May 2000. A second graft biopsy was carried out, which revealed no sign of CsA-associated nephropathy, rejection, or nephritis. However, the SCr level increased gradually to 1.2mg/dl.We therefore suspected CsA-associated functional nephropathy and gradually lowered the CsA trough level to 50ng/ml while administering mycophenolate mofetil(MMF)(2g/day). After September 2000 the SCr level was maintained between 0.7 and 0.8mg/dl. We should reconsider the past protocol for livingrelated renal transplantation based on calcineurin inhibitors and steroids.
信州医学会の論文