Izvolskaja Nina, Rainiene Tatjana, Dainys Balys
Antakalnis Hospital of Vilnius University, Lithuania.
Medicina (Kaunas). 2003;39 Suppl 1:166-70.
Acute rejection is a known risk factor for developing chronic allograft nephropathy, which remains as a major cause of long-term graft loss. Daclizumab (Zenapax), a humanized anti interleukin-2 receptor (IL-2R) alpha monoclonal antibody, is a novel selective immunosuppressive agent for the prophylaxis of acute rejection. Six patients (aged from 32 to 48) after cadaver and living donor kidney transplantation (Tx) have been treated with Daclizumab since 2000 in Lithuania. Daclizumab was prescribed (1.0 mg/kg intravenously before Tx and once every other week afterwards (five dozes in total) for all patients, except one, who received two dozes. The induction therapy was administered due to various immunological risk factors: retransplantated, sensitized and poorly HLA-matched patients, as well as non-immunological risk factors such as patients with diabetes, with kidney from sub-optimal donors, obesity of patients, etc. The maintenance immunosuppression consisted of cyclosporine, mycophenolate mofetil and prednisolon in all patients except one, who was treated without steroids. All the patients have been folloved-up for 5-36 months. Within the observation period in early time after Tx all the patients are alive and have no clinical signs of rejection. The graft function is normal (serum creatinine ranges between 100-120 micromol/l).
Induction therapy with Daclizumab is safe and efficacious in preventing acute rejection in high risk kidney recipients.
急性排斥反应是发生慢性移植肾肾病的已知危险因素，而慢性移植肾肾病仍是长期移植肾失功的主要原因。达利珠单抗（赛尼哌）是一种人源化抗白细胞介素-2受体（IL-2R）α单克隆抗体，是一种用于预防急性排斥反应的新型选择性免疫抑制剂。自2000年以来，立陶宛有6例（年龄在32至48岁之间）尸体供肾和活体供肾移植患者接受了达利珠单抗治疗。除1例接受2次剂量的患者外，所有患者均在移植前静脉注射达利珠单抗1.0mg/kg，此后每隔一周注射一次（共5次剂量）。由于各种免疫危险因素（再次移植、致敏和HLA配型不佳的患者）以及非免疫危险因素（如糖尿病患者、供肾质量欠佳的患者、肥胖患者等）而进行诱导治疗。除1例未使用类固醇治疗的患者外，所有患者的维持免疫抑制方案均包括环孢素、霉酚酸酯和泼尼松龙。所有患者均随访了5至36个月。在移植后的早期观察期内，所有患者均存活，且无排斥反应的临床体征。移植肾功能正常（血清肌酐范围在100 - 120μmol/L之间）。
达利珠单抗诱导治疗在预防高风险肾移植受者的急性排斥反应方面安全有效。
