| Objective: To explore the tacrolimus blood concentration distribution,coagulation function index,liver and kidney function changes and influencing factors in liver transplant recipients using tacrolimus as the main anti-rejection treatment plan for clinical liver transplant.The monitoring of tacrolimus and blood concentration range provide a reference,provide a basis for predicting possible adverse reactions,and ensure the safety and security of tacrolimus.Methods:A retrospective study of 85 patients undergoing allogeneic orthotopic liver transplantation in our hospital from September 2015 to October 2019.After screening,71 patients were selected for the study of coagulation function,and the patients were collected before and after liver transplantation1-5dcoagulation-related indicators:prothrombin time(PT),activated partial thromboplasting time(APTT),thrombin time(TT),blood platelet(PLT),and Fibrinogen(FBG).All data were collected for statistical analysis.At the same time,66 patients were screened for blood concentration and liver and kidney function research.Tacrolimus blood concentration test data at different time periods after surgery were selected.Summarize and analyze the blood concentration distribution of tacrolimus after clinical liver transplantation;meanwhile,collect liver function aspartate transaminase(ALT),aspartate transaminase(AST)and renal function serum creatinine(Scr)at various stages within180 days after surgery,and retrospectively analyze the liver after operation reasons for the sharp changes in renal function,and the trend of liver and kidney function changes after long-term follow-up.All data conform to normal distribution by t test,otherwise Wilcoxon rank sum test.Results:The coagulation function indexes PT,APTT,TT and FBG of patients before and after liver transplantation gradually recovered and approached normal values within d1-5 after operation,but PLT gradually decreased during d1-5 after operation,d2-5 was statistically significant compared with that before surgery.The average blood concentration of tacrolimus within 30 days after operation was 7.39 ±3.18 ng/m L,and the concentration of 39% was within the range of 6-10 ng/m L.The average blood concentration at 90 days after operation was 6.32±3.09ng/m L,with a concentration of 58% in the range of 4 to 8 ng/m L;the average blood concentration at 180 days after surgery was 6.43±3.03ng/m L,and a concentration of 55% was in the range of 4-8ng/m L.In 66 patients,ALT and AST peaked on the first day after surgery,and both of them gradually decreased to normal levels within 30 days after surgery.At 180 days after surgery,the two indicators remained basically within the normal range,which was not statistically different from that before surgery.After the first day of Scr,it suddenly increased and recovered within one week.The Scr at 180 days was significantly higher than the preoperative value(P=0.0131<0.05).Conclusions:For long-term application of tacrolimus,the platelet reduction caused by tacrolimus cannot be ignored.The therapeutic amount of tacrolimus may cause platelet aggregation and lead to a decrease in platelet count.Induction of immunotherapy or tacrolimus in combination with sirolimus can delay or reduce the application of tacrolimus,maintain the concentration of tacrolimus at the lowest maintenance level,and prevent renal rejection while preventing kidneys toxicity.The damage of tacrolimus to the kidney is slowly accumulated,and the renal function damage caused by tacrolimus can be improved by combining sirolimus. |
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