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器官移植免疫抑制剂临床应用技术规范(2019版)

中华医学会器官移植学分会

中华医学会器官移植学分会. 器官移植免疫抑制剂临床应用技术规范(2019版)[J]. 器官移植, 2019, 10(3): 213-226. doi: 10.3969/j.issn.1674-7445.2019.03.001
引用本文: 中华医学会器官移植学分会. 器官移植免疫抑制剂临床应用技术规范(2019版)[J]. 器官移植, 2019, 10(3): 213-226. doi: 10.3969/j.issn.1674-7445.2019.03.001
Branch of Organ Transplantation of Chinese Medical Association. Technical specifcation for clinical application of immunosuppressive agents in organ transplantation (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 213-226. doi: 10.3969/j.issn.1674-7445.2019.03.001
Citation: Branch of Organ Transplantation of Chinese Medical Association. Technical specifcation for clinical application of immunosuppressive agents in organ transplantation (2019 edition)[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 213-226. doi: 10.3969/j.issn.1674-7445.2019.03.001

器官移植免疫抑制剂临床应用技术规范(2019版)

doi: 10.3969/j.issn.1674-7445.2019.03.001
基金项目: 

国家自然科学基金 81570680

详细信息
    通讯作者:

    石炳毅,Email:shibingyi666@126.com

  • 中图分类号: R617, R392.4

Technical specifcation for clinical application of immunosuppressive agents in organ transplantation (2019 edition)

  • 摘要: 为了进一步规范器官移植免疫抑制剂的临床应用,中华医学会器官移植学分会组织全国31家移植中心的器官移植专家,从器官移植免疫诱导药物应用技术规范、器官移植维持期免疫抑制剂应用技术规范、器官移植常用免疫抑制方案技术规范、器官移植免疫抑制剂血药浓度监测技术规范、器官移植药物性肝肾损伤治疗技术规范等方面,制订本规范,以帮助器官移植工作者规范和优化器官移植免疫抑制剂的临床应用。

     

  • 图  1  各种免疫抑制剂的作用环节示意图

    APC为抗原提呈细胞;IL为白细胞介素;TCR为T细胞受体;JAK为Janus激酶;PI3K为磷脂酰肌醇-3-激酶;mTOR为哺乳动物雷帕霉素靶蛋白;CN为钙调磷酸酶;MAP激酶为有丝分裂原活化蛋白激酶;IKK为核因子-κB激酶抑制剂;NFAT为活化T细胞核因子;AP-1为激活蛋白因子;CKD/cyclins为周期蛋白依赖激酶;IMPDH为次黄嘌呤核苷酸脱氢酶。图引自HALLORAN PF, KREEPALA C, EINECKE G, et al. Therapeutic approaches to organ transplantation [M]//LI XC, JEVNIKAR AM. Transplant Immunology. Hoboken: Wiley Online Library, 2015

    Figure  1.  Schematic diagram of the action of various immunosuppressive agents

    表  1  中国肾移植受者应用CsA联合MPA和糖皮质激素三联方案的目标浓度(ng/mL)

    Table  1.   Target concentration of triplet regimen of CsA combined with MPA and glucocorticoid in Chinese renal transplant recipients

    移植后时间 C0 C2
    < 1个月 150~300 1 000~1 500
    1~3个月 150~250 800~1 200
    4~12个月 120~250 600~1 000
    > 12个月 80~120 > 400
    下载: 导出CSV

    表  2  中国肾移植受者应用FK506联合MPA和糖皮质激素三联方案的目标浓度(ng/mL)

    Table  2.   Target concentration of triplet regimen of FK506 combined with MPA and glucocorticoid in Chinese renal transplant recipients

    移植后时间 C0
    < 1个月 8~12
    1~3个月 6~10
    3~12个月 4~10
    > 12个月 4~8
    下载: 导出CSV
  • [1] DJAMALI A, TURC-BARON C, PORTALES P, et al. Low dose antithymocyte globulins in renal transplantation: daily versus intermittent administration based on T-cell monitoring[J]. Transplantation, 2000, 69(5):799-805. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_LWW2017052520706396
    [2] UBER WE, UBER LA, VANBAKEL AB, et al. CD3 monitoring and thymoglobulin therapy in cardiac transplantation: clinical outcomes and pharmacoeconomic implications[J]. Transplant Proc, 2004, 36(10):3245-3249. doi: 10.1016/j.transproceed.2004.11.099
    [3] 石炳毅, 郑树森, 刘永峰.中国器官移植临床诊疗指南[M].北京:人民卫生出版社, 2017.
    [4] WANG X, QIN X, WANG Y, et al. Controlled-dose versus fixed-dose mycophenolate mofetil for kidney transplant recipients: a systematic review and Meta-analysis of randomized controlled trials[J]. Transplantation, 2013, 96(4):361-367. DOI: 10.1097/TP.0b013e31828c6dc7.
    [5] BRENNAN DC, LEGENDRE C, PATEL D, et al. Cytomegalovirus incidence between everolimus versus mycophenolate in de novo renal transplants: pooled analysis of three clinical trials[J]. Am J Transplant, 2011, 11(11):2453-2462. DOI: 10.1111/j.1600-6143.2011.03674.x.
    [6] VEROUX M, TALLARITA T, CORONA D, et al. Sirolimus in solid organ transplantation: current therapies and new frontiers[J]. Immunotherapy, 2011, 3(12):1487-1497. DOI: 10.2217/imt.11.143.
    [7] THOMUSCH O, WIESENER M, OPGENOORTH M, et al. Rabbit-ATG or basiliximab induction for rapid steroid withdrawal after renal transplantation (Harmony): an open-label, multicentre, randomised controlled trial[J]. Lancet, 2016, 388(10063):3006-3016.DOI: 10.1016/S0140-6736(16)32187-0.
    [8] 陈实.移植学[M].北京:人民卫生出版社, 2011.
    [9] AITHAL GP, WATKINS PB, ANDRADE RJ, et al. Case definition and phenotype standardization in drug-induced liver injury[J]. Clin Pharmacol Ther, 2011, 89(6):806-815. DOI: 10.1038/clpt.2011.58.
    [10] 何晓顺, 朱晓峰.多器官移植与器官联合移植[M].广州:广东科技出版社, 2009.
    [11] USUI J, YAMAGATA K, IMAI E, et al. Clinical practice guideline for drug-induced kidney injury in Japan 2016: digest version[J]. Clin Exp Nephrol, 2016, 20(6):827-831. DOI: 10.1007/s10157-016-1334-0.
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出版历程
  • 收稿日期:  2019-02-20
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-05-15

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