Vathsala A
Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Transplant Proc. 2004 Sep;36(7):1868-70. doi: 10.1016/j.transproceed.2004.08.132.
Since the first renal transplant (RTx) in 1956 in Asia in Japan, over 100,000 RTx have been performed in over 300 centers across the region. A survey was conducted to evaluate immunosuppression (IS) use among Asian RTx. Briefly, directors of RTx centers were surveyed regarding IS use for RTx performed at their centers in 2001 for (1) induction therapy, (2) maintenance IS therapy at hospital discharge, (3) antirejection treatment (REJ) to 1 year post-RTx, and (4) maintenance IS therapy to 1 year post-RTx. Categories and types of IS included in the survey were polyclonal antilymphocyte antibodies (PAB), OKT3, IL2 receptor antibodies (IL2RAb), corticosteroids (CS), cyclosporine (CyA), tacrolimus (Tac), azathioprine (Aza), mycophenolate mofetil (MMF), Mizoribine (Miz), Sirolimus (Sir), and other agents. Though only 17 RTx centers in Asia responded to the survey, a wide variation in IS use was demonstrated. In the 334 living and 85 cadavericRTx among whom actual usage was reported, induction therapy was used in only 18.4% of Asian RTx (14.1%, IL2RAb; 4.3%, PAB), in contrast to the 59.3% reported as using induction IS among RTx from the UNOS database in the same year. For maintenance therapy at hospital discharge, 87.1% of Asian RTx received CyA-based IS while only 12.4% received Tac-based therapy. This is in contrast to the 55.3% use of Tac for new RTx in the United States. Generic CyA has widespread use in Asia with over 29.9% on CyA using generic versus the Neoral formulation. Azathioprine is still the predominant antimetabolite in use in Asian RTx, with MMF being used in only 33.6% of patients, in contrast to its 77% usage in the United States. Usage of Tac and MMF for maintenance therapy was significantly higher among cadavericRTx (P < .005). Corticosteroids were used in 51.1% of REJ episodes while PAB or OKT3 were used in 31.9% and 17% of REJ episodes, respectively. As these results may be skewed due to participation of few centers in the survey, greater participation will ensure more accurate evaluation of immunosuppression use in Asia for de novo RTx.
自1956年亚洲首例肾移植手术在日本开展以来，该地区300多家中心已实施了超过10万例肾移植手术。一项调查旨在评估亚洲肾移植中免疫抑制治疗（IS）的使用情况。简要来说，对肾移植中心主任就其中心2001年肾移植手术的免疫抑制治疗使用情况进行了调查，涉及（1）诱导治疗，（2）出院时的维持免疫抑制治疗，（3）肾移植后1年的抗排斥治疗（REJ），以及（4）肾移植后1年的维持免疫抑制治疗。调查中包含的免疫抑制治疗类别和类型有：多克隆抗淋巴细胞抗体（PAB）、OKT3、白细胞介素2受体抗体（IL2RAb）、皮质类固醇（CS）、环孢素（CyA）、他克莫司（Tac）、硫唑嘌呤（Aza）、霉酚酸酯（MMF）、咪唑立宾（Miz）、西罗莫司（Sir）以及其他药物。尽管亚洲仅有17家肾移植中心回应了此次调查，但免疫抑制治疗的使用情况仍呈现出很大差异。在报告了实际使用情况的334例活体肾移植和85例尸体肾移植中，亚洲肾移植手术仅18.4%采用了诱导治疗（14.1%使用IL2RAb；4.3%使用PAB），而同年美国器官共享联合网络（UNOS）数据库报告的肾移植手术中诱导免疫抑制治疗的使用率为59.3%。出院时的维持治疗方面，87.1%的亚洲肾移植患者接受了以环孢素为基础的免疫抑制治疗，而仅12.4%的患者接受了以他克莫司为基础的治疗。这与美国新肾移植手术中他克莫司55.3%的使用率形成对比。普通环孢素在亚洲广泛使用，使用普通环孢素而非新山地明制剂的比例超过29.9%。硫唑嘌呤仍是亚洲肾移植手术中使用的主要抗代谢药物，仅有33.6%的患者使用霉酚酸酯，而在美国其使用率为77%。尸体肾移植中他克莫司和霉酚酸酯用于维持治疗的比例显著更高（P <.005）。51.1%的抗排斥治疗发作使用了皮质类固醇，而PAB或OKT3分别在31.9%和17%的抗排斥治疗发作中使用。由于参与调查的中心较少，这些结果可能存在偏差，更多的参与将确保对亚洲初发肾移植免疫抑制治疗的使用情况进行更准确的评估。
