摘要： Kidney transplant recipients are at a high risk for H1N1infection associated complications during the current pandemic. Prevention of infection by immunization, together with early recognition and prompt antiviral treatment are critical. Post-exposure prophylaxis of H1N1 with oseltamivir was safe, effective and well tolerated to prevent H1N1 influenza A virus infection in newly transplanted renal allograft recipient receiving triple immunosuppression without any interaction with tacrolimus level. Oseltamivir was effective for post-exposure prophylaxis of H1N1 in close contact. © JAPI.

关键词： Medication Nonadherence   Recipients   Health Care Policy   Insurance Coverage   Pharmaceutical Preparations   Kidney Transplantation   kidney transplant rejection   Transplant Recipient   Response Frequency  

摘要： Background and objectives: Immunosuppressive medications are essential in preventing kidney transplant rejection. Continuous insurance coverage for outpatient immunosuppressive medications remains a major issue. The objective of this study was to establish the prevalence and consequences of cost-related immunosuppressive medication nonadherence. Design, setting, participants, & measurements: A descriptive survey of all U.S. kidney transplant programs (n = 254) was conducted. The response rate for the survey exceeded 99%. The main outcome measures included the following: transplant recipient concerns related to medication costs, ability to pay for medications, medication nonadherence and its consequences, and failure of transplant centers to place patients on the transplant waiting list. Results: Continuous insurance coverage for outpatient immunosuppressive drugs is a problem having potentially grave consequences for the majority of kidney transplant recipients. More than 70% of kidney transplant programs report that their patients have an extremely or very serious problem paying for their medications. About 47% of the programs indicate that more than 40% of their patients are having difficulty paying for their immunosuppressive medications. In turn, 68% of the programs report deaths and graft losses attributable to cost-related immunosuppressive medication nonadherence. Some of the problems identified here are more significant for adult than pediatric patients. Conclusions: The prevalence and consequences of cost-related immunosuppressive medication nonadherence among kidney transplant recipients have now been documented. The results presented here should serve as the necessary impetus for the development of health care policies supporting Medicare coverage of immunosuppressive medications for the life of the transplanted kidney. Clin J Am Soc Nephrol 5: 2323-2328, 2010. doi: 10.2215/CJN.04220510

关键词： Influenza A virus, H1N1 Influenza   immunosuppressive agents   heart transplantation  

关键词： 免疫抑制药物   肝损害   肾移植术后   肾移植患者   引发   药物性肝中毒   常见并发症   病毒性肝炎  

摘要： 免疫抑制药物引起的肝损害是实体器官移植术后的常见并发症,且为移植患者死亡的主要原因之一。以肾移植为例,肾移植术后肝损害的发病率在20%～50%,发病原因主要有药物性肝中毒、病毒性肝炎、巨细胞病毒(CMV)感染。而导致肾移植患者死亡的原因中,肝功能衰竭占8%～28%。因此,进一步明确各免疫抑制药的肝毒性有重要的临床意义。

关键词： 移植物排斥反应   免疫抑制药物   移植受者   服药依从性   长期存活   移植肾功能延迟恢复   器官   群体反应性抗体  

摘要： 器官移植后受者和移植物的长期存活始终是移植界所关心的主要问题。但是，影响受者和移植物长期存活的原因有很多，包括免疫性因素（免疫抑制不足、急性排斥反应、群体反应性抗体、再次肾移植、HLA配型）和非免疫因素（移植肾缺血时间、急性肾小管坏死和移植肾功能延迟恢复、原发性肾脏病、高血压、高脂血症、供受者之间的不匹配）等。在众多因素中，受者的服药依从性对免疫抑制剂的血药浓度产生很大影响，擅自减或停用免疫抑制剂可直接导致严重的移植物排斥反应，影响移植物的长期存活。下面我们将就受者的不依从现象、不依从造成的严重后果和药物因素造成的不依从等进行分析和讨论。

关键词： T cells   rejection   immunosuppressants   calcineurin inhibitors   belatacept   abatacept  

摘要： Transplant tolerance is an important issue in the clinical practice. Successful transplant depends on the ability to block the rejection of the transplanted organ. Currently, improving transplant tolerance is accomplished using immunosuppressive agents, but having also many toxic effects on the host body. So far, the conventional immunosuppressive therapy with calcineurin inhibitors such as cyclosporine or the newer tacrolimus, is the most common way to treat and prevent rejection;but, since the appearance of the fusion proteins, it became clear that the transplanted patients might have a chance for life-on-therapy but without the many toxic effects of the conventional immunosuppressive therapy. This new drug category - co-stimulation blockers - have the potential to eventually replace current therapies to become the new standard therapy of immunosuppression after organ transplantation.

摘要： In addition to having the privilege of serving as Editor-in-Chief of the Clinical Journal of the American Society of Nephrology, I necessarily have a day job. For the past 40 years, I have functioned clinically as a renal transplant physician. Currently there is little disagreement that patients who receive a renal transplant have superior outcomes in terms of length and quality of life compared with similar patients who remain on dialysis but who are on the transplant waiting list (1). In 2010, transplantation is denied to patients who cannot afford their immunosuppressive medications and increasingly for those who have only Medicare coverage because their reimbursement benefit runs out after 36 *** the current debate about health care reform, there was bipartisan agreement that extension of these immunosuppressive benefits for the lifetime of the transplant made good clinical and economic sense because Medicare pays for dialysis for the duration of a patient's life, a much more expensive therapy than kidney transplantation. This common sense addition to the health care reform bill was scuttled by the Senate because of input from many lobbying groups, including those associated with the dialysis industry and the National Kidney Foundation. This seems counterintuitive to most of us involved in caring for transplant *** complex issues involved in these legislative processes are discussed in two editorials by prominent transplant physicians in this issue of CJASN. The goal of these editorials is to inform the nephrology community about what has transpired and the consequences of professional organizations being in lock step with industry, which has a different perspective on what is best for ***, pitting the interests of one group of patients against those of another was not the goal of any professional society or corporation. However, this does not obviate the fact that in 2010, patients who are good candidates for the preferred form o

关键词： 免疫抑制药物   肾毒性   防治  

摘要： 免疫抑制药物除有明确的临床疗效外,在应用过程中也发现了不同程度的不良反应,不同免疫抑制药物不良反应的临床表现和实验室检查特点也不同,可通过检测血药水平及联合用药等方法预防这些药物的肾损害。现简要介绍不同免疫抑制剂对肾脏病理和肾功能等的影响及如何进行监测和防治。

关键词： 免疫抑制剂   儿童   药物监测   免疫法   色谱法,高压液相   串联质谱法  

摘要： 免疫抑制剂是一类特殊的专科用药,虽然在儿童中应用较成人少,但药品的作用机制导致不良反应发生率高,许多免疫抑制剂在药动学和药效学上又存在着明显的个体差异,所以对服用免疫抑制剂的儿童患者,药物监测同样需得到重视。本文选取了最有代表性的微生物来源免疫抑制剂,分别对其药物特点、适应证以及可行的分析方法进行综述,希望对开展儿童免疫抑制药物的治疗监测起到借鉴作用。

关键词： 亲属活体供肾移植   活体肾移植   高峰论坛   免疫抑制药物   杭州   浙江大学医学院   摘要   附属第一医院  

摘要： 据报道，2008年中国肾移植数量达6000例左右，其中活体供肾移植约占45％。而2008美国器官分配网络（UNOS）数据显示，2007年美国活体供肾移植为6037例，活体供肾移植的受者和移植物存活率均优于尸体肾移植。世界各国为了解决器官紧缺而制约器官移植发展的瓶颈问题，活体供肾移植所占比例均逐年升高。2009年10月10日由浙江大学医学院附属第一医院主办的《2009年活体肾移植杭州高峰论坛》在杭州举行，浙江大学医学院的郑树森院士和陈江华教授为大会主席。