신이식 환자의 면역어제제 다제요법에 따른 모니터링과 부작용 분석

Abstract

Multidrug combination of immunosuppressive agents have been used to achieve an optimal immunosuppression and prevent adverse effects of immunosuppressant in kidney transplant patients. Cyclosporine and tacrolimus are mostly used immunosuppressive drugs out of preferred immunosuppressive regimens for the prevention of rejection after kidney transplantation. Due to variable pharmacokinetic profiles and frequent adverse reactions with immunosuppressants such as cyclosporin, tacrolimus, and mycophenolate mofetil, the studies related to therapeutic drug monitoring (TDM) of immunosuppressive regimen have continuously been researched. The aims of this study were to analyze monitoring and adverse effects on immunosuppressive multidrug regimens in renal transplant patients. Medical records of 58 patients who were performed renal transplantation and selected based on inclusion criteria between January 2002 and July 2013 were reviewed retrospectively. Data of 20 patients were excluded from analysis for various reasons; changed immunosuppressive drugs (n=11) and withdrawn medical records (n=9). The included patients were divided into two group: cyclosporine (CsA) + mycophenolate mofetil (MMF) + steroid group (CsA group, n=28) and tacrolimus (TAC) + MMF + steroid (TAC group, n=10) group at 12 months post-transplant. As a result, the triglyceride level of the CsA group was significantly increased compared with that of the TAC group at 3, 9 and 12 months (p=0.008, p=0.007, p=0.033, respectively). The dyslipidemia complications of CsA group were higher than that of TAC group at 3, 6, and 12 month after transplantation (p=0,044, p=0.043, p=0.048, respectively). The AST level of CsA group was significantly increased compared with that of the TAC group at 3 month (p=0.002). This study also showed that TAC regimen tends to increase a glucose level during 12 months. Therefore, this study reassures that patients treated with CsA regimen needs to be closely monitored regarding lipid profiles and liver function test, and patients treated with TAC regimen needs to be cautiously monitored about blood glucose levels to prevent complications by adverse effects during immunosuppressive therapy. Further prospective studies with larger number of patients in multi-centers and longer follow-ups are needed to confirm this study in a single tertiary hospital and to optimize the therapeutic effects of immunosuppressive multidrug regimens with safety and efficacy to prevent transplant rejection.