| 【Objective】 In this study,we compared the prophylactic treatment of DCD donor kidney transplantation recipients with anti-fungal drugs,such as caspofungin and micafungin,the incidence of fungal infection,adverse reactions,tacrolimus trough concentration/dose ratio and serum creatinine,and explored the clinical efficacy and safety of caspofungin and micafungin in the prophylactic treatment of DCD donor kidney transplantation recipients.To provide references for finding safe and effective prophylactic antifungal agents for renal transplant recipients with DCD donors.【Methods】 285 recipients of DCD donor kidney transplantation were selected from the Second Affiliated Hospital of South China University and the Third Xiangya Hospital of Central South University from June 2016 to June 2018.According to the principle of randomization,the patients were divided into caspofungin group,micafungin group and blank control group,95 cases in each group.Caspofungin injection group received 70 mg/d first day loading dose followed by 50 mg/d prophylactic antifungal treatment for 2 weeks;Micafungin injection group received 50 mg/d prophylactic antifungal treatment for 2 weeks;blank control group did not use prophylactic antifungal treatment.Triple immunosuppressive regimen of mycophenolate mofetil+FK506+methylprednisolone was used in all three groups after operation.follow-up to 3 months after operation,pay close attention to the changes of symptoms and signs,and regularly detect liver,kidney function,electrolyte and FK506 trough concentration.If the patient has infection-related symptoms and signs,fungi(1-3)-beta-D_glucan test(G test),Aspergillus galactomannan test(GM test),sputum smear microscopy,blood,urine,sputum fungi culture and imaging examination of the infection site,if necessary,bronchoalveolar lavage fluid microscopy and puncture specimen microscopy and culture of the culture or infection site were detected.The fungal infection rates of the three groups were counted.To observe and record the adverse reactions of three groups of recipients during medication,valley concentration/dose ratio of FK506 and serum creatinine were measured at all follow-up time points.To evaluate the clinical efficacy and safety of two drugs for prophylactic treatment of fungal infections after operation.【Results】 Three groups of recipients were followed up for 3 months,89 cases in caspofungin group,88 cases in micafungin group and 90 cases in blank control group.Postoperative clinical diagnosis of fungal infection was 0% in caspofungin group,4 cases in micafungin group,4.5% in fungal infection,12 cases in blank control group,13.3% in fungal infection,and the fungal infection rates in caspofungin group and micafungin group were lower than those in blank control group(P < 0.0).5)The fungal infection rate of caspofungin group was lower than that of micafungin group(P < 0.05).Adverse reactions occurred in 17 cases(19.1%)of gastrointestinal reactions,11 cases(12.4%)of electrolyte disorders,4 cases(4.5%)of liver injury,4 cases(4.5%)of infusion phlebitis,3 cases(3.4%)of skin rash,2 cases(2.2%)of headache and dizziness,1 case(1.1%)of visual abnormalities,and 18 cases(20.4%)of gastrointestinal reactions and electrolysis in the Micafungin group.10 cases(11.4%),5 cases(5.7%)of liver injury,3 cases(3.4%)of infusion phlebitis,2 cases(2.2%)of skin rash,3 cases(3.4%)of headache and dizziness,1 case(1.1%)of anxiety,and 1 case(8.9%)of adverse reactions occurred in the blank control group during the same period: 15 cases(16.7%)of gastrointestinal reaction,8 cases(8.9%)of electrolyte disorder,2 cases(2.2%)of liver injury,1 case(1.1%)of infusion phlebitis,2 cases of skin rash.(2.2%,headache,dizziness in 2 cases(2.2%);other(anxiety,visual abnormality,etc.)in 0 cases(0%);the incidence of adverse reactions in the three groups was similar,and there was no significant difference(P > 0.05).The mean values of the trough concentration/dose ratio of FK506 at each follow-up time point after renal transplantation in the three groups were similar,with no significant difference(P > 0.05).The mean serum creatinine values of the three groups were similar at all follow-up time points after renal transplantation,with no significant difference(P > 0.05).【Conclusion】Both caspofungin and micafungin can effectively reduce the fungal infection rate of recipients after DCD renal transplantation.Caspofungin is better than micafungin in preventing fungal infection.The safety of caspofungin and micafungin is similar,they do not affect the use of FK506 and the recovery of renal function,and do not significantly increase the incidence of adverse reactions after renal transplantation. |
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