Kode Ravi, Fa Kosunarty, Chowdhury Shoaib, Ranganna Karthik, Fyfe Billie, Stabler Susan, Damask Anna, Laftavi Mark R, Kumar Anil Mysore, Pankewycz Oleh
MCP-Hahnemann University, Philadelphia, PA, University of Pennsylvania, Philadelphia, PA and SUNY-University at Buffalo, Buffalo General Hospital, Buffalo, NY 14203, USA.
Clin Transplant. 2003 Aug;17(4):369-76. doi: 10.1034/j.1399-0012.2003.00061.x.
Current immunosuppressive therapies are very effective in preventing acute rejection (AR) and graft loss following renal transplantation. Newer agents now make it possible to develop equally efficacious but better tolerated and less toxic strategies. This is especially relevant for our ageing recipients. We now compare the efficacy of basiliximab combined with early low-dose cyclosporin therapy to standard OKT3 induction therapy.
In this single-centre study, 100 consecutive recipients of cadaveric kidney transplants from November 1998 to August 2000 were treated with basiliximab combined with early low-dose cyclosporin, reduced steroids and mycophenolate mofetil (MMF). Clinical outcomes at 100 d and 1 yr were compared with a group of 26 patients transplanted from March 1995 to November 1998 who received OKT3, delayed full-dose cyclosporin, high-dose steroids and MMF. Amongst basiliximab treated patients, we compared clinical outcomes in those older and younger than 60 yr.
Both groups were similar except for a shorter cold ischaemic time in the basiliximab group. Length of stay, number of readmissions, total hospitalization days and cytomegalovirus infections were lower in the basiliximab group. Despite a 40% reduction in steroids, basiliximab-treated patients had fewer biopsy-proven episodes of AR (basiliximab 14% vs. OKT3 35%) and required less antilymphocyte antibody therapy. Clinical outcomes including patient and graft survival were no different between groups. Long-term graft survival for patients over 60 yr was limited primarily by mortality.
Compared with OKT3 induction therapy, the combination of early low-dose cyclosporin and basiliximab is steroid sparing, effective, well tolerated and relatively safe.
目前的免疫抑制疗法在预防肾移植后的急性排斥反应（AR）和移植肾丢失方面非常有效。新型药物使得开发同样有效但耐受性更好、毒性更小的策略成为可能。这对于我们日益老龄化的受者尤为重要。我们现在比较巴利昔单抗联合早期低剂量环孢素治疗与标准OKT3诱导治疗的疗效。
在这项单中心研究中，1998年11月至2000年8月连续100例尸体肾移植受者接受了巴利昔单抗联合早期低剂量环孢素、减量类固醇和霉酚酸酯（MMF）治疗。将100天和1年时的临床结果与1995年3月至1998年11月接受OKT3、延迟全剂量环孢素、高剂量类固醇和MMF治疗的26例患者进行比较。在接受巴利昔单抗治疗的患者中，我们比较了年龄大于和小于60岁患者的临床结果。
除巴利昔单抗组冷缺血时间较短外，两组相似。巴利昔单抗组的住院时间、再入院次数、总住院天数和巨细胞病毒感染率较低。尽管类固醇减少了40%，但接受巴利昔单抗治疗的患者经活检证实的AR发作较少（巴利昔单抗组为14%，OKT3组为35%），且所需的抗淋巴细胞抗体治疗较少。两组间包括患者和移植肾存活在内的临床结果无差异。60岁以上患者的长期移植肾存活主要受死亡率限制。
与OKT3诱导治疗相比，早期低剂量环孢素和巴利昔单抗联合使用可节省类固醇，有效，耐受性良好且相对安全。
