兔抗胸腺细胞球蛋白与OKT3在心肺移植和肺移植后诱导治疗中的比较：对生存、排斥反应、感染和闭塞性细支气管炎的影响。

Rabbit antithymocyte globulin versus OKT3 induction therapy after heart-lung and lung transplantation: effect on survival, rejection, infection, and obliterative bronchiolitis.

作者信息

Barlow C W, Moon M R, Green G R, Gamberg P, Theodore J, Reitz B A, Robbins R C

机构信息

Department of Cardiothoracic Surgery, Mailpoint 46, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.

出版信息

Transpl Int. 2001 Aug;14(4):234-9. doi: 10.1007/s001470100314.

DOI:10.1007/s001470100314

PMID:11512056

Abstract

The superiority of different induction therapies after heart-lung and lung transplantation is not clearly established; specifically, whether monoclonal (OKT3) or polyclonal antibody induction therapy provides any advantage. Between 1989 and 1991 we used induction therapy with either rabbit antithymocyte globulin (RATG) or OKT3, given at random based on the availability of RATG. RATG was used in 25 patients (RATG group 1) and OKT3 in 38 patients (OKT3 group 1). Early results suggested a survival advantage with RATG. From 1992 until 1997 we used RATG induction therapy in 108 patients (RATG group 2). This study analyzed longer-term survival, infection, rejection, and obliterative bronchiolitis (OB) rates for RATG group 1 and OKT3 group 1 and assessed outcomes for RATG group 2. The 1-, 3-, and 5-year survival for RATG group 1 was 72 %, 72 %, and 52 % and for OKT3 group 1 was 63 %, 49 %, and 34 % (P < 0.05). The 1- and 3-year survival for RATG group 2 was 84 % and 74 %. The 1-, 3-, and 5-year actuarial freedom rates from lung rejection for RATG group 1 were 38 %, 38 %, and 31 % and for OKT3 group 1 were 21 %, 0 %, and 0 % (P < 0.01). The linearized rate (events/100 patient days) of all infections at 3 months was 1.55 +/- 0.28 for RATG group 1 and 2.19 +/- 0.27 for OKT3 group 1 (P = NS). The infection rate for RATG group 2 was 1.60 +/- 0.13. The actuarial rates of freedom from OB at 1, 3, and 5 years for RATG group 1 were 84 %, 51 %, and 45 % and for OKT3 group 1 were 77 %, 61 %, and 36 % (P = NS), while for RATG group 2 the rates were 97 % and 92 % at 1 and 3 years (P < 0.01 vs RATG group 1 and OKT3 group 1). The use of RATG induction therapy from 1989 through 1991 resulted in improved actuarial survival and less rejection, without increased infection rates. The use of RATG since 1992 has continued to result in similar outcomes for survival, infection, and rejection. The time to onset of OB has improved further in recent years. This may be a result of recent improvements in cytomegalovirus (CMV) prophylaxis.

摘要

心肺移植和肺移植后不同诱导疗法的优势尚未明确确立；具体而言，单克隆（OKT3）或多克隆抗体诱导疗法是否具有任何优势尚不明确。1989年至1991年期间，我们根据兔抗胸腺细胞球蛋白（RATG）的可获得性随机使用RATG或OKT3进行诱导治疗。25例患者使用了RATG（RATG组1），38例患者使用了OKT3（OKT3组1）。早期结果显示RATG具有生存优势。1992年至1997年期间，我们对108例患者使用了RATG诱导治疗（RATG组2）。本研究分析了RATG组1和OKT3组1的长期生存率、感染率、排斥反应率和闭塞性细支气管炎（OB）发生率，并评估了RATG组2的治疗结果。RATG组1的1年、3年和5年生存率分别为72%、72%和52%，OKT3组1分别为63%、49%和34%（P<0.05）。RATG组2的1年和3年生存率分别为84%和74%。RATG组1的1年、3年和5年肺排斥反应精算自由率分别为38%、38%和31%，OKT3组1分别为21%、0%和0%（P<0.01）。3个月时，RATG组1所有感染的线性化发生率（事件/100患者日）为1.55±0.28，OKT3组1为2.19±0.27（P=无显著性差异）。RATG组2的感染率为1.60±0.13。RATG组1的1年、3年和5年OB精算自由率分别为84%、51%和45%，OKT3组1分别为77%、61%和36%（P=无显著性差异），而RATG组2在1年和3年时的比率分别为97%和92%（与RATG组1和OKT3组1相比，P<0.01）。1989年至1991年使用RATG诱导治疗可提高精算生存率并减少排斥反应，且不增加感染率。自1992年以来使用RATG在生存、感染和排斥反应方面继续产生类似的结果。近年来，OB的发病时间进一步改善。这可能是由于近年来巨细胞病毒（CMV）预防措施的改进。