Perner F, Alföldy F, Járay J, Hidvégi M, Hemangshu P
Transplantation and Surgical Clinic, Semmelweis University of Medicine, Budapest, Hungary.
Transpl Int. 1994;7 Suppl 1:S255-8. doi: 10.1111/j.1432-2277.1994.tb01361.x.
A total of 793 kidney transplantations (KTx) were performed from November 1073 to March 1993. Two hundred and forty-two patients were treated with conventional immunosuppression (azathioprine + prednisolone) and all the others with cyclosporine (Sandimmun) and prednisolone (SIM + PRED). The survival of the second graft was less good in both therapeutic groups than that of the first ones, so we have started to use preventive immunotherapy with OKT3 (CILAG) in combination with SIM (both before operation) and PRED. We compared 32 SIM-PRED patients with 20 OKT3 + SIM + PRED patients. All underwent a second KTx. The two groups were found to be comparable and homogeneous with regard to 14 of 18 parameters analysed statistically. Statistically significant differences were found between the two groups as regards the frequency of acute rejection within 30 days (46.69% vs 20%), the delta creatinine value on the 1st and 2nd postoperative days (-4.3: -8 vs -8.6: -19.7%), patient survival after 4 years (78.2 vs 100%), and graft survival after 1 and 4 years (-58.9: -42.8 vs -83.5: -83.5%), with better results in the OKT3 group. We conclude that the preventive use of OKT3 simultaneously with SIM + PRED for the second KTx is the method of choice to prevent rejection and improve survival. This treatment results in patient and graft survival following the second KTx being as good as after the first KTx with SIM + PRED.
1973年11月至1993年3月期间共进行了793例肾移植手术（KTx）。242例患者接受传统免疫抑制治疗（硫唑嘌呤+泼尼松龙），其余所有患者接受环孢素（山地明）和泼尼松龙治疗（SIM+PRED）。两个治疗组中第二次移植的存活率均低于第一次移植，因此我们开始使用OKT3（CILAG）联合SIM（均在术前）和PRED进行预防性免疫治疗。我们将32例接受SIM-PRED治疗的患者与20例接受OKT3+SIM+PRED治疗的患者进行了比较。所有患者均接受了第二次肾移植手术。在统计分析的18项参数中的14项上，发现两组具有可比性且同质化。在30天内急性排斥反应的发生率（46.69%对20%）、术后第1天和第2天的肌酐变化值（-4.3：-8对-8.6：-19.7%）、4年后的患者存活率（78.2对100%）以及1年和4年后的移植存活率（-58.9：-42.8对-83.5：-83.5%）方面，两组之间存在统计学上的显著差异，OKT3组的结果更好。我们得出结论，对于第二次肾移植手术，预防性使用OKT3同时联合SIM+PRED是预防排斥反应和提高存活率的首选方法。这种治疗方法使得第二次肾移植手术后患者和移植肾的存活率与第一次使用SIM+PRED时一样好。
