| Objective: To study the effect of tacrolimus on the change of immunocyte of liver transplant recipients with different survival time. To explore proper ranges of tacrolimus trough concentration for liver transplant recipients with different survival time.Methods:1 27 liver transplant recipients accepted tacrolimus monotherapy were selected as experimental group and divided into 2 groups according to their survival time: 1year?group A<5year n=16, 5year?group B?12year n=11. Healthy adults between 41 to 59 years were selected as control. The tacrolimus trough concentration was detected by the chemical luminescence immunoassay method. The percentages of T lymphocyte(CD3+, CD3+CD4+, CD3+CD8+), B lymphocyte(CD19+), NK cell(CD16+CD56+) of participants were detected by flow cytometry. The correlations between the levels of immunocyte and tacrolimus trough concentration, ALT, AST, ALB, GGT were analyzed respectively.2 1224 cases of tacrolimus trough concentrations of 105 liver transplant recipients visiting during January 2013-December 2014 were retrospectively analyzed. The measurement values of tacrolimus trough concentration were divided into 3 groups according to patients' survival period: group?<1year, 1year ? group ?< 5year, 5year?group ? ?12year, aiming to analyze the changes of tacrolimus trough concentrations in each groups.Results:1 The tacrolimus trough concentration of liver transplant recipients in group B was significantly lower than that in group A(P=0.022). In group B,CD3+CD4+ frequencies?the value of CD4+/CD8+ were significantly lower,and CD3+CD8+ frequencies was significantly higher compared to those in the control group(P(CD3+CD4+)=0.040,P(CD4+/CD8+)=0.002,P(CD3+CD8+)=0.012). There were no significant changes between other groups(P>0.05). Otherwise, the level of ALT was inversely correlated with the percentage of CD3+CD4+ cells(rsCD3+CD4+=-0.414 PCD3+CD4+=0.032), and positively correlated with the percentage of B cells(rsB=0.447 PB=0.019), and no linear correlation with CD3+,CD3+CD8+ and NK cells(P>0.05). The levels of AST,GGT,ALB and tacrolimus trough concentration were not linearly correlated with the levels of T,B and NK cells(P>0.05).2 Among the 1224 case of tacrolimus trough concentration values, the lowest value was 0.20ng/ml, the highest was 19.80ng/ml, the average was(6.10±2.96) ng/ml, and 91.91 percentage of the monitoring values were distributed in the 2-12ng/ml. The tacrolimus trough concentration in group I, II and III were(7.29±2.87),(5.00±2.33),(3.18±2.09) ng/ml respectively, and there were significant differences between every two groups(P < 0.05). In group I, 78.17 percentage of cases were distributed in 4-10ng/ml, In group ?,72.08 percentage of cases were distributed in 2-6ng/ml, In group ?,76.14 percentage of cases were distributed in 0-4ng/ml.Conclusions:1 Immune function of liver transplant recipients with more than 5 years survival time was suppressed by tacrolimus. Tacrolimus trough concentration and the levels of CD3+CD4+, CD3+CD8+, CD4+/CD8+, ALT may reflect the immune status of recipients and help to understand the immune status, adjust the dose of tacrolimus and avoid the excessive immunosuppression.2 The recommended range of tacrolimus trough concentration were 2~10ng/ml. Then with time prolonged, the range was adjusted to 4-10ng/ml within 1 year, 2~6ng/ml within 1~5 year, 2~4ng/ml within 5~12 year after transplantation. It's suggested to maintain a higher tacrolimus trough concentration in the early post-operation, and individual adjustment of medication in the long term post-operation need full considerdtion of the factors of age, weight, primary disease, complications. |
PDF Full Text Request