単施設における生体腎移植の三剤併用免疫抑制療法の検討

Abstract

シクロスポリンを導入した1989年1月～2003年7月に施行した生体腎移植35例を, その導入免疫抑制療法に基づき, A群:シクロスポリン(CsA)+アザチオプリン(AZ)+ステロイド(Pred)16例, B群:タクロリムス(TAC)+AZ+Pred 9例, C群:TAC+ミコフェノール酸モフェチル(MMF)+Pred 9例の3群に分け, 後ろ向きに検討した.全34例において死亡例は認めず, 移植腎の生着率においても移植腎機能喪失をA群, B群において各1例ずつ認めたのみで, 各群間に有意差は認められなかった.移植後3ヵ月における血清クレアチニン濃度はA群とB群の間で有意差を認めたが, 移植後1年では有意差を認めなかった.移植後1年における尿潜血の陽性率はA, B, C各群間で有意差を認めなかった.移植後1年以内の急性拒絶反応はA, B, C各群で統計学的には有意差は認めなかった

We reviewed the outcome of three methods employed for living-related renal transplantation (RTx) in our institution to assess triple immunosuppressive regimens. Between January 1989 and July 2003, a total of 35 living-related RTxs were performed at our institution. The immunosuppressive regimen given to 16 patients (group A) was cyclosporine (CsA), steroid and azathoprine (AZ) that given to 9 patients (group B) was tacrolimus (TAC), steroid and AZ and that given 9 patients (group C) was TAC, steroid and mycophenolate mofetil (MMF). Graft survival rate, serum creatinine, proteinuria, acute rejection, chronic allograft nephropathy (CAN), cytomegalovirus (CMV) infection and drug-induced nephropathy were investigated. There was no significant difference in graft survival rate among the three groups. Although serum creatinine levels (mg/dl) at 3 months post-transplant were 1.22+/-0.37 in group A, 1.43+/-0.14 in group B, 1.30+/-0.34 in group C, respectively (p<0.05; A vs. B), there was no significant difference at 1 year post-transplant. Frequency of proteinuria in groups A, B and C was 75.0, 50.0, 25.0%, respectively (p<0.05; A vs. C). The incidences of acute rejection and CAN within 1 year post-transplant were, respectively, 56.3% and 43.8% in group A, 37.5% and 37.5% in group B; and, 25.0% and 12.5% in group C (NS). The incidence of drug-induced nephrotoxicity was 12.5, 50.0% and 37.5% in groups A, B and C, respectively (p<0.05; A vs. B). The triple immunosuppressive therapy including calcineurin inhibitors, especially the regime of TAC, MMF, and steroids decreased the frequencies of proteinuria and rejections, which deteriorated the long-term outcome in living-related RTxs.