摘要
目的评价新型免疫抑制剂在人类异体手移植中的应用及其近期效果.方法术前经组织配型选取合适供者.供者脑死亡后,自肘关节上10 cm切取上肢,2～4℃UW液灌注后置无菌冰桶内保存.受者术前2 d开始口服FK506、霉酚酸酯(MMF)、强的松(Pred),术中甲基强的松龙(MP)1.5 g冲击,术后第1天开始,MP 1.0 g静脉滴注,连续3 d,抗胸腺细胞球蛋白(ATG)100 mg静脉滴注,连续10 d,并口服FK506、MMF、Pred,通过检测FK506血谷值浓度调整其用量,Pred 50mg维持3个月后递减,通过对患者临床表现、生化检查、多种免疫指标监测以及移植手的皮肤活检,观察异体手的功能恢复及移植排斥反应.结果移植手血循环良好,感觉、运动功能逐渐改善.患者各项免疫学指标正常,肝、肾及胃肠道功能良好.术后2、4、8周移植手皮肤活检证明无排斥反应,术后第7周移植手皮肤发生红色丘疹,取活检送病理检查证实无排斥反应,经局部炉甘石洗剂擦洗后治愈.1例术后血糖升高,现用胰岛素治疗.结论良好的组织配型,免疫抑制剂的合理应用,在异体手移植手术成功后可以预防移植排斥反应,移植手近期功能至少不比自体手再植差.
Objective To study the clinical application and observe the short-term effect of the new immunosuppressive drugs in human hand allotransplantation. Methods The donor was selected according to the histocompatability test result when brain death occurred. The upper limb of the donor was amputated from 10 cm above the albow, followed by immediate perfusion with UW solution at 2 to 4 ℃ and was preserved in the aseptic barrel with ice. Oral tacrolimus (FK506), mycophenolate mofetil(MMF) and prenisone were prescribed for the 2 recipients 2 d before the transplantation and during the operation, 1 500 mg methylpredisone (MP) was administered. The immunosuppression therapy with MP (1.0 g/d for 3 d), Antithymocyte globuin (ATG 100 mg/d, for 10 d), FK506, MMF and predison started on the first day following the operation, and the dosage of FK 506 was adjusted on the basis of its blood trough level and 3 months after implementing the therapy, predisone dosages were gradually reduced. The function recovery and graft rejection were monitored by regular observation of clinical manifestations, biochemical examination, immunologic inspection and skin biopsies. Results The transplanted hand showed good circulation and the sensory and motor function recovered gradually. All the immunologic indicators monitored and the hepatic, renal and gastrointestinal functions were normal. Skin biopsies of the allografts at 2, 4 and 8 weeks after the operation ruled out graft rejection episodes. Seven weeks after the transplantation, red papules occurred in the skin of the allograft but biopsies proved no rejection, and the papules were eliminated with calamine swabbing. One recipient developed hyperglycemia and is currently receiving insulin therapy. Conclusion Allograft rejection can be prevented by well-matched histocompatability and appropriate application of immunosuppressive drugs, and the short-term function recovery of the allograft is by no means inferior to that of the autograft.
出处
《第一军医大学学报》
CSCD
北大核心
2001年第9期679-681,共3页
Journal of First Military Medical University
关键词
手移植
异体移植
免疫抑制剂
allotransplantation
hand transplantation
immunosuppressant
