Objective: To investigate the treatment and clinical effect of renal toxicity caused by tacrolimus in the condition of biliary infection after liver transplantation. Methods: The clinical data of one patient with renal toxicity caused by tacrolimus in the condition of biliary infection after liver transplantation was retrospectively analyzed, renal function was recovered through the exchange with sirolimus. The patients of liver transplantation with Percutaneous Transhepatic Choledochus Drainage (PTCD) had fever because of biliary infection, the gastrointestinal symptoms of nausea and vomiting appeared on the basis of infection control, which was related to the renal toxicity induced by tacrolimus, sirolimus was then used to replace tacrolimus. Results: Biliary infection after liver transplantation induced renal toxicity, On the basis of control of biliary infection, sirolimus was used to replace tacrolimus, and dilatation as well as fluid infusion were used to improve the renal perfusion, the renal function of patient gradually recovered. Conclusion: Sirolimus is a kind of low renal toxicity immune inhibitor, the conversion therapy of sirolimus can effectively protect renal function with the renal toxicity caused by tacrolimus after liver transplantation.%目的:探讨肝移植术后胆道感染的情况下他克莫司导致肾毒性的处理措施及临床疗效.方法:回顾性分析我科收治的1例肝移植术后服用他克莫司导致肾毒性的患者,换周西罗莫司后肾功能恢复的临床资料.患者因移植术后胆道狭窄,行经皮肝胆管穿刺引流术(PTCD)治疗后出现发热,明确诊断为胆道感染,予以控制感染.继之出现恶心、呕吐等消化道症状,明确为他克莫司导致肾毒性所致,治疗上停用他克莫司胶囊,服用西罗莫司.结果:肝移植术后胆道感染促进他克莫司导致肾毒性的发生,在胆道感染控制的基础上,予以换用他克莫司为西罗莫司,同时扩容、补液等改善肾脏灌注治疗后,患者的肾功能逐渐恢复,现于我院门诊跟踪并规律复查.结论:西罗莫司是一种低肾毒性的免疫抑制剂,对于肝移植术后他克莫司导致肾毒性的处理,换用西罗莫司治疗能有效保护肾功能.
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