| Objective:To explore the difference of tacrolimus trough concentration of recipients in simultaneous liver kidney transplantation compared to that in liver transplantation and kidney transplantation,and comparison of early graft function recovery between combined liver-kidney transplantation and simple liver transplantation and simple renal transplantation under rountion immunosuppressive agent.Methods:A retrospective study was conducted,24 patients of the organ transplant admitted to Affiliated Hospital of Qingdao University from July 2014 to July 2017 were enrolled,and they were divided into combined liver and kidney transplant(SLK)group,single liver transplant group and single renal transplant group,8 cases in each group.Value of the valley concentration of tacrolimus whole blood trough,liver and kidney function test(alanine aminotransferase ALT,aspartate aminotransferase AST,total bilirubin TB,creatinine Cr,usea nitrogen BUN)of the recipients in three groups were collected.The FK506C0 and liver and renal function were compared between the three groups within 1 month,2~3 months and 4~6 months after transplantation.Results: 1.The differences of tacrolimus trough concentration in three groups within 1 month,and 2 to 3 months were not statistically significant(P>0.05).But within 4~6 months after operation,the tacrolimus trough concentration in SLK group was lower than that in simple renal transplantation group,the difference was statistically significant(P<0.05),and the tacrolimus trough concentration in simple liver transplantation group was lower than that of simple renal transplantation group,the difference was statistically significant(P<0.05),but there was no significant difference between the SLK group and the simple liver transplantation group(P>0.05).2.Compared with the simple liver transplantation group,the level of ALT in SLK group was higher within 1 month and 2 to 3 months after operation,and the difference was statistically significant(P<0.05),no significant differences in AST and TB were found(P>0.05),within 4 to 6 months after operation,the level of AST in SLK group was higher than that in simple liver transplantation group,the difference was statistically significant(P<0.05),no significant differenceswere found in ALT and TB(P>0.05).Compared with simple kidney transplantation,the difference of Cr and BUN in SLK group were statistically significant(P<0.05)within 1 month after operation.Within 2 to 3 months after operation,the level of Cr in SLK group was lower,and the difference was statistically significant(P<0.05),and no significant difference of BUN was found(P>0.05).There was no significant difference in Cr and BUN within 4~6 months after operation(P>0.05).Conclusion: 1.The graft liver in SLK patients may have immune protection to the transplanted kidney.But the formation of this protective effect may be related to postoperative time.2.In the early stage after combined liver and kidney transplantation,the application of immunosuppressive agents in patients can be adjusted according to the simple liver transplantation scheme.Because of individual differences,immunosuppressive agents can be adjusted by monitoring the immune state of patients and the changes of liver and kidney function,so as to develop individualized immunosuppressive scheme.So that patients can avoid rejection while minimizing the dose of rejection,thus reducing the incidence of complications such as infection.3.The common causes of abnormal graft function after organ transplantation are postoperative complications,infection,acute or chronic rejection,drug damage and so on.Therefore,the graft function and blood concentration of organ transplant recipients should be monitored regularly after operation.The immune status of the transplant recipients should be understood,the dose of tacrolimus should be adjusted in time to avoid the prevention of over-infection,drug-induced graft damage,immune deficiency and rejection. |
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