急性拒絶反応の診断

Abstract

生体腎移植の中, HLA matchingがone haplo identicalで, 免疫抑制法としてM-Pr.とAz.を使用したC群25例とCsAとの3剤併用T群25例を対象とした.T群ではCsA through levelの測定3回後投与量を変えた.中部地区腎移植33施設の免疫抑制法, CsA使用後の急性拒絶反応の診断法, 発生率のアンケートを行った.1)免疫抑制法:3剤併用22施設, 2)急性拒絶反応の診断は従来通り.発生率は半数の施設で減少した.当院でのCsA使用の有無で急性拒絶反応発生頻度に有意差はなかった.CsA使用後の拒絶反応発生の診断は困難になったが従来の方法で十分である

A questionnaire survey, concerning the immunosuppressive treatment and criteria of diagnosis in acute rejection of renal allografts, was done at 22 institutes. In 15 institutes, 3 immunosuppressive agents were used. Those agents were as follows: prednisolone (Pr.) or methyl-prednisolone (M-Pr.), cyclosporin (CsA) and azathioprine (Az.) or mizoribine (Mz.) or anti-lymphocyte globulin (ALG). A combination of 4 drugs (Pr. or M-Pr. +CsA +Az. or Mz. +ALG) was used at 4 institutes and a combination of 2 drugs (Pr. or M-Pr. +CsA) at the remaining 3 institutes. Acute rejection episodes were diagnosed by conventional criteria in all institutes. Conventional criteria were as follows: physical findings, rising serum creatinine, response to pulse therapy, rising urinary FDP, decreasing urinary Na/K ratio and radionuclide findings. In our cases, there was no significant difference between the number of acute rejection episodes by the 25 patients who underwent conventional immunosuppressive therapy (C group:M-Pr.+Az.) and the 25 patients with triple immunosuppressive therapy (T group: M-Pr. +CsA+Az.). Conventional methods were sufficient in most cases of the T as well as C group to diagnose acute rejection episodes.