儿童肝移植中他克莫司浓度个体内变异
收稿日期: 2022-02-10
网络出版日期: 2022-06-16
Tacrolimus intra-patient variability in pediatric liver transplantation
Received date: 2022-02-10
Online published: 2022-06-16
目的： 研究儿童肝移植术后他克莫司浓度个体内变异（tacrolimus intra-patient variability,Tac-IPV）和对移植预后的影响。方法： 本单中心回顾性研究纳入392例儿童肝移植受者。所有患儿均在术后采用Tac为基础的免疫抑制方案。通过变异系数（coefficient of variation,CV）和Tac变异评分（Tac variability score,TVS）分别计算Tac-IPV。结合随访及穿刺结果,分析并发症发生组和正常恢复组IPV的差异。分析两种计算方法得到的IPV对移植术后相关并发症发生的影响。结果： 本研究共纳入男童175例,女童217例。移植时月龄为（24.73±36.58）个月。肝移植术后3年内的Tac-CV中位数分别为0.386 3、0.317 0、0.291 3,第4~5年的Tac-CV中位数为0.296 1。采用CV计算IPV,排斥反应、肝纤维化等并发症发生组与正常恢复组的IPV差异无统计学意义。采用TVS计算,术后肝纤维化组1~12个月IPV（P=0.011）和4~12个月IPV（P=0.001）与正常恢复组的差异有统计学意义。结论： 儿童肝移植术后前3年Tac-IPV逐年下降。Tac-IPV升高可能与肝纤维化等不良临床结局有关。
吴浩翔, 吕子成, 侯宇宸, 张子杰, 乔子耘, 冯浩, 夏强 . 儿童肝移植中他克莫司浓度个体内变异[J]. 外科理论与实践, 2022 , 27(02) : 145 -151 . DOI: 10.16139/j.1007-9610.2022.02.012
Objective To study tacrolimus intra-patient variability (Tac-IPV) after liver transplantation in children and the influence on prognosis of transplantation. Methods A total of 392 pediatric liver transplant recipients were included in this single-center retrospective study. All children were treated with Tac-based immunosuppressive therapy postoperatively. Tac-IPV was calculated using both coefficient of variation (CV) and Tac variability score (TVS) methods. According to both follow-up and biopsy results, the difference in IPV was analyzed between complication group and normal recovery group. The influence of IPV on postoperative complications after transplantation were analyzed using two calculation methods. Results There were 175 males and 217 females with(24.73±36.58) months of age when transplantation included in this study. After pediatric liver transplantation, the median Tac-CV was 0.386 3, 0.317 0, and 0.291 3 in the first three years respectively, and 0.296 1 in 4-5 years. There was no significant difference in IPV calculated by CV between complication group and normal recovery group, such as rejection and liver fibrosis. However, the difference in IPV was significant statistically calculated by TVS within 1-12 months (P=0.011) and 4-12 months (P=0.001) between postoperative liver fibrosis group and normal recovery group. Conclusions After pediatric liver transplantation, Tac-IPV decreased in the first 3 years. Increase in Tac-IPV may be associated with poorer clinical outcomes such as liver fibrosis.
Key words： Tacrolimus; Intra-patient variability; Liver transplantation
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