Wall W J
Multi-Organ Transplant Program, London Health Sciences Centre-University Campus, London, Ontario, Canada.
Liver Transpl Surg. 1999 Jul;5(4 Suppl 1):S64-70. doi: 10.1053/JTLS005s00064.
Polyclonal and monoclonal antilymphocyte agents (antilymphocyte globulin, antithymocyte globulin, OKT3, anti-interleukin-2 receptor antibody) are potent immunosuppressive agents that differ fundamentally in their mechanisms of action from cyclosporine- and tacrolimus-based induction therapy. Clinical trials and retrospective studies show low rates of acute rejection can be obtained when biological antilymphocyte agents are used for induction immunosuppression in liver transplant recipients. Infectious complications are similar to those of conventional induction regimens, and the incidence of posttransplant lymphoproliferative disease is acceptably low when excessive doses are not used. Published series of liver transplant recipients have so far not shown the clear superiority of antilymphocyte induction therapy, in terms of patient and graft survival, compared with standard therapy (cyclosporine or tacrolimus plus steroids and azathioprine). At present, there is no ideal induction regimen recommended for all patients.
多克隆和单克隆抗淋巴细胞制剂（抗淋巴细胞球蛋白、抗胸腺细胞球蛋白、OKT3、抗白细胞介素-2受体抗体）是强效免疫抑制剂，其作用机制与基于环孢素和他克莫司的诱导治疗有根本区别。临床试验和回顾性研究表明，在肝移植受者中使用生物抗淋巴细胞制剂进行诱导免疫抑制时，急性排斥反应的发生率较低。感染性并发症与传统诱导方案相似，且在不过量使用的情况下，移植后淋巴增殖性疾病的发生率可接受地低。迄今为止，已发表的肝移植受者系列研究尚未显示出与标准治疗（环孢素或他克莫司加类固醇和硫唑嘌呤）相比，抗淋巴细胞诱导治疗在患者和移植物存活方面具有明显优势。目前，尚无推荐用于所有患者的理想诱导方案。
