Ciancio Gaetano, Burke George W, Gaynor Jeffrey J, Mattiazzi Adela, Roohipour Ramin, Carreno Manuel R, Roth David, Ruiz Phillip, Kupin Warren, Rosen Anne, Esquenazi Violet, Tzakis Andreas G, Miller Joshua
Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA.
Transplantation. 2004 Aug 15;78(3):426-33. doi: 10.1097/01.tp.0000128625.29654.eb.
In an attempt to reduce both initial and long-term (nephrotoxic) calcineurin inhibitor maintenance dosage and totally eliminate maintenance corticosteroids, alemtuzumab (Campath-1H) was used as induction therapy in first cadaver and non-HLA-identical living donor renal transplantation.
Forty-four de novo renal allograft recipients were treated with Campath-1H (0.3 mg/kg) on days 0 and 4 postoperatively, preceded by methylprednisolone boluses. Maintenance target 12-hr tacrolimus trough levels of 5 to 7 ng/mL were operational from the outset as well as (reduced) mycophenolate mofetil dosage of 500 mg twice daily. No corticosteroids were planned to be given after the first week postoperatively.
With a median follow-up of 9 (range, 1-19) months, patient and graft survival rates are each at 100%. Biopsy-proven acute rejection was diagnosed in four patients. Infections requiring hospitalization developed in four patients. Thirty-eight recipients remain without the need for long-term corticosteroid therapy.
In an early assessment, the combination of Campath-1H, low dosing of tacrolimus and mycophenolate mofetil, and avoidance of maintenance corticosteroid use seems to be safe and effective for kidney transplant recipients. Long-term outcomes will be reported in the future.
为了降低钙调神经磷酸酶抑制剂的初始剂量和长期（肾毒性）维持剂量，并完全停用维持性皮质类固醇，在首例尸体供肾及非 HLA 配型相同的活体供肾肾移植中，使用阿仑单抗（Campath-1H）进行诱导治疗。
44 例初次接受肾移植的受者在术后第 0 天和第 4 天接受 Campath-1H（0.3 mg/kg）治疗，术前给予甲泼尼龙冲击治疗。从一开始就将他克莫司 12 小时谷浓度的维持目标设定为 5 至 7 ng/mL，并将霉酚酸酯剂量减至每日两次、每次 500 mg。术后第一周后不再计划给予皮质类固醇。
中位随访时间为 9（1 - 19）个月，患者和移植物存活率均为 100%。4 例患者经活检证实发生急性排斥反应。4 例患者发生需要住院治疗的感染。38 例受者仍无需长期皮质类固醇治疗。
在早期评估中，Campath-1H、低剂量他克莫司和霉酚酸酯联合应用以及避免使用维持性皮质类固醇对肾移植受者似乎是安全有效的。长期结果将在未来报告。
