不进行抗淋巴细胞诱导的同期肾胰联合移植。

Simultaneous kidney-pancreas transplantation without antilymphocyte induction.

作者信息

Reddy K S, Stratta R J, Shokouh-Amiri H, Alloway R, Somerville T, Egidi M F, Gaber L W, Gaber A O

机构信息

Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536, USA.

出版信息

Transplantation. 2000 Jan 15;69(1):49-54. doi: 10.1097/00007890-200001150-00010.

DOI:10.1097/00007890-200001150-00010

PMID:10653379

Abstract

BACKGROUND

The introduction of potent new immunosuppressive agents may allow simultaneous kidney-pancreas transplantation to be performed without antilymphocyte induction.

METHODS

We analyzed 30 simultaneous kidney-pancreas transplantations receiving tacrolimus, mycophenolate mofetil, and steroids without without antilymphocyte induction. Eighteen patients underwent pancreas transplantation with portal-enteric (P-E) drainage and the remaining 12 had systemic bladder (S-B) drainage. Target 12 hr trough tacrolimus levels for the first 3 months after simultaneous kidney-pancreas transplantation were 15-20 ng/ml. The oral mycophenolate mofetil dose was 2-3 g/day begun immediately posttransplant in two to four divided doses. Steroids were tapered according to protocol.

RESULTS

All patients experienced immediate function of both kidney and pancreas grafts. One-year actuarial patient, kidney, and pancreas graft survival rates are 93, 93, and 90%, respectively. Nine patients (30%) had a total of 13 rejection episodes (12 biopsy proven) including 4 within 2 weeks, 6 between 2 weeks and 3 months, and 3 beyond 3 months after simultaneous kidney-pancreas transplantation. Three rejection episodes were treated with steroids alone and 10 were treated with antilymphocyte therapy (5 OKT3 and 5 ATGAM). A total of seven patients (23%) received antilymphocyte therapy. Three patients (10%) had more than one rejection episode. Two pancreas grafts (7%) and one kidney graft (3%) were lost from rejection. Four patients (13%) developed cytomegalovirus infection, but none had tissue-invasive cytomegalovirus. At present, 22 surviving patients (81%) remain on triple immunosuppression with tacrolimus, mycophenolate mofetil, and prednisone with excellent dual graft function.

CONCLUSION

Tacrolimus, mycophenolate mofetil, and prednisone immunosuppression without without antilymphocyte induction is safe and effective after simultaneous kidney-pancreas transplantation.

摘要

背景

强效新型免疫抑制剂的引入可能使同期肾胰联合移植在不进行抗淋巴细胞诱导的情况下得以实施。

方法

我们分析了30例接受他克莫司、霉酚酸酯和类固醇治疗且未进行抗淋巴细胞诱导的同期肾胰联合移植病例。18例患者接受了门静脉-肠道（P-E）引流的胰腺移植，其余12例采用全身膀胱（S-B）引流。同期肾胰联合移植术后前3个月他克莫司的目标12小时谷浓度为15 - 20 ng/ml。口服霉酚酸酯剂量为2 - 3 g/天，移植后立即开始，分2 - 4次服用。类固醇根据方案逐渐减量。

结果

所有患者的肾和胰腺移植物均立即发挥功能。患者、肾和胰腺移植物的1年预期生存率分别为93%、93%和90%。9例患者（30%）共发生13次排斥反应（12次经活检证实），其中4次发生在术后2周内，6次发生在2周与3个月之间，3次发生在同期肾胰联合移植术后3个月之后。3次排斥反应仅用类固醇治疗，10次采用抗淋巴细胞治疗（5次用OKT3，5次用抗胸腺细胞球蛋白）。共有7例患者（23%）接受了抗淋巴细胞治疗。3例患者（10%）发生了不止一次排斥反应。2例胰腺移植物（7%）和1例肾移植物（3%）因排斥反应而丢失。4例患者（13%）发生了巨细胞病毒感染，但均无组织侵袭性巨细胞病毒感染。目前，22例存活患者（81%）仍接受他克莫司、霉酚酸酯和泼尼松的三联免疫抑制治疗，双移植物功能良好。