Joyal Dominique, Cantarovich Marcelo, Cecere Renzo, Giannetti Nadia
Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada.
Clin Transplant. 2004 Oct;18(5):493-6. doi: 10.1111/j.1399-0012.2004.00189.x.
Daclizumab is a human monoclonal antibody that binds to the interleukin-2 receptor. It has been used as induction therapy in heart transplantation with repeated administrations over several weeks. At our institution, we use a two-dose regimen of daclizumab based on its extended half-life. We sought to determine the incidence of acute rejection with 2-dose daclizumab in cardiac transplantation.
Eighteen consecutive heart transplants performed at a single center were analyzed retrospectively. Patients received daclizumab (2 mg/kg) within 8 h of cardiac transplantation and a second dose (1 mg/kg) 2 wk thereafter. Maintenance immunosupression included mycophenolate mofetil, prednisone and either cyclosporine or tacrolimus, based on side-effect profile. The endpoint was the incidence of acute rejection as defined by a histologic grade >2 according to the classification of the International Society of Heart and Lung Transplantation.
Four patients had acute rejections (all were 3A) during the first 3 months post-transplantation. All four patients had rejection at the first biopsy and only two had rejection thereafter. None of the rejections were hemodynamically significant and no patients were hospitalized. All except one rejection was seen in the context of low 2-h cyclosporine levels. The two-dose regimen was easier to administer on an outpatient basis and resulted in lower cost.
This preliminary report suggests that induction therapy with a two-dose regimen of daclizumab appears to be safe and well tolerated in patients undergoing cardiac transplantation.
达利珠单抗是一种结合白细胞介素-2受体的人源单克隆抗体。它已被用于心脏移植的诱导治疗，在数周内重复给药。在我们机构，基于其延长的半衰期，我们使用两剂量方案的达利珠单抗。我们试图确定两剂量达利珠单抗在心脏移植中急性排斥反应的发生率。
回顾性分析在单一中心进行的18例连续心脏移植病例。患者在心脏移植后8小时内接受达利珠单抗（2mg/kg），并在2周后接受第二剂（1mg/kg）。维持免疫抑制包括霉酚酸酯、泼尼松以及根据副作用情况选用环孢素或他克莫司。终点是根据国际心肺移植学会的分类，组织学分级>2所定义的急性排斥反应的发生率。
4例患者在移植后前3个月发生急性排斥反应（均为3A级）。所有4例患者在首次活检时出现排斥反应，此后仅有2例出现排斥反应。所有排斥反应均无血流动力学意义，且无患者住院。除1例排斥反应外，所有排斥反应均在2小时环孢素水平较低的情况下出现。两剂量方案在门诊给药更容易，且成本更低。
这份初步报告表明，达利珠单抗两剂量方案的诱导治疗在心脏移植患者中似乎是安全的且耐受性良好。
