Tan Michael, Cantarovich Marcelo, Mangel Roman, Paraskevas Steven, Fortier Michelle, Metrakos Peter
Department of General Surgery, Section of Transplantation, McGill University Health Centre, Montreal, Quebec, Canada.
Clin Transplant. 2002 Dec;16(6):414-8. doi: 10.1034/j.1399-0012.2002.02031.x.
Graft survival following solitary pancreas transplantation has traditionally lagged behind that of simultaneous pancreas-kidney transplants. Thymoglobulin (TMG), a polyclonal rabbit-derived antilymphocyte antibody was originally introduced as treatment for acute rejection of renal allografts. However, data regarding the efficacy of TMG induction in solitary pancreas transplants is lacking. We present the 1-yr graft survival and acute rejection rate of 22 solitary pancreas transplants performed at the McGill University Health Centre using reduced dose TMG induction with lower dose tacrolimus and mophetil mycophenolate.
Eighteen pancreas after kidney and four pancreas transplants alone were performed between January 1998 and October 2000 at McGill University. Induction therapy with TMG at a starting dose of 1.5 mg/kg/d was started 12 h post-operatively. The daily dose of TMG was held if the total leukocyte count was <2,500/mm3 or if the lymphocyte count was <100/mm3. Maintenance therapy was initiated with steroids (tapered to 20 mg prednisone orally once a day) tacrolimus (2 mg twice a day), and mofetil mycophenolate (1 g daily).
Patients received three to seven doses of TMG over the first seven post-operative days at a dose of 0.85 +/- 0.27 mg/kg/d (mean +/- SD). The mean follow-up was 1.28 +/- 0.14 yr. The 1-yr patient and graft survival was 100% (22 of 22) and 96% (21 of 22), respectively. The 1 yr acute rejection rate was 27.3% (six of 22). Five of the six rejections responded to steroid boluses. One was refractory to steroids and TMG resulting in graft loss. Presumed rejections were diagnosed on the basis of decreasing urine amylase and/or hyperglycemia.
Monitoring the total leukocyte and lymphocyte count resulted in a 43% reduction in the amount of TMG used compared with the recommended dosing. Despite the reduced amounts, patient and graft survival were excellent with acute rejection rates comparing favorably to other published series.
传统上，单纯胰腺移植后的移植物存活率落后于同期胰肾联合移植。胸腺球蛋白（TMG）是一种兔源多克隆抗淋巴细胞抗体，最初被用作肾移植急性排斥反应的治疗药物。然而，关于TMG诱导在单纯胰腺移植中的疗效数据尚缺乏。我们报告了在麦吉尔大学健康中心进行的22例单纯胰腺移植的1年移植物存活率和急性排斥反应率，这些移植采用了低剂量TMG诱导联合低剂量他克莫司和霉酚酸酯。
1998年1月至2000年10月期间，在麦吉尔大学进行了18例肾后胰腺移植和4例单纯胰腺移植。术后12小时开始用起始剂量为1.5mg/kg/d的TMG进行诱导治疗。如果白细胞总数<2500/mm³或淋巴细胞计数<100/mm³，则停用TMG的每日剂量。维持治疗开始时使用类固醇（逐渐减量至口服泼尼松20mg/天1次）、他克莫司（2mg/天2次）和霉酚酸酯（1g/天）。
患者在术后头7天接受了3至7剂TMG，剂量为0.85±0.27mg/kg/d（平均值±标准差）。平均随访时间为1.28±0.14年。1年时患者和移植物存活率分别为100%（22例中的22例）和96%（22例中的21例）。1年急性排斥反应率为27.3%（22例中的6例）。6例排斥反应中有5例对类固醇冲击治疗有反应。1例对类固醇和TMG耐药，导致移植物丢失。根据尿淀粉酶降低和/或高血糖诊断为疑似排斥反应。
与推荐剂量相比，监测白细胞和淋巴细胞计数使TMG的使用量减少了43%。尽管用量减少，但患者和移植物存活率良好，急性排斥反应率与其他已发表系列相比具有优势。
