Takano Y, Takahara S, Kokado Y, Kameoka H, Ishibashi M, Jiang H, Okuyama A, Sonoda T
Department of Urology, Osaka University Medical School.
Nihon Hinyokika Gakkai Zasshi. 1992 Feb;83(2):230-5. doi: 10.5980/jpnjurol1989.83.230.
We report here the favorable results of clinical application of 15-deoxyspergualin (DSG) as a rescue therapy for rejection episodes in kidney transplant recipients. DSG was discovered in Japan and was proved to be a novel immunosuppressant in various animal transplantation models. The immunosuppressive mechanism of DSG is unclear yet, but its point of action is supposed to be in the early immuno response to allogeneic stimulation without the regulation of cytokine production. We performed the administration of DSG in fifteen patients, who had rejection episodes, with a dosage of 3 mg/kg/day or 5 mg/kg/day for five days by drip infusion. In the group of recipients who had rejection episodes within six months after kidney transplantation, DSG proved effective on six out of seven acute rejection episodes and induced favorable remission. And in the group of recipients who had rejection episodes after six months since kidney transplantation, DSG proved effective on all of ten rejection episodes. There was not a difference of effectiveness in respect to the dosage of DSG. The side effect of DSG treatment was mainly leukopenia but in most cases these leukopenia was remitted just under careful observation. Some patients complained the sense of abdominal discomfort. But so far, we did not encounter serious or critical side effects and complications during all the time of progression. Another benefit was that DSG was able to reverse the rejection episode even in the patient who had already treated with anti lymphocyte globulin and/or anti CD3 monoclonal antibody OKT3. We concluded that the administration of DSG as a rescue therapy was not accompanied by the serious side effects and was most effective against acute rejection after kidney transplantation.
我们在此报告15-去氧精胍菌素（DSG）作为肾移植受者排斥反应发作的挽救疗法的临床应用的良好结果。DSG在日本被发现，并在各种动物移植模型中被证明是一种新型免疫抑制剂。DSG的免疫抑制机制尚不清楚，但其作用点应该是在对同种异体刺激的早期免疫反应中，而不调节细胞因子的产生。我们对15例发生排斥反应的患者进行了DSG给药，剂量为3mg/kg/天或5mg/kg/天，持续五天，通过静脉滴注。在肾移植后六个月内发生排斥反应的受者组中，DSG对七次急性排斥反应中的六次被证明有效，并诱导了良好的缓解。而在肾移植六个月后发生排斥反应的受者组中，DSG对十次排斥反应全部有效。DSG的剂量在有效性方面没有差异。DSG治疗的副作用主要是白细胞减少，但在大多数情况下，这些白细胞减少在仔细观察下就会缓解。一些患者抱怨有腹部不适感。但到目前为止，在整个治疗过程中，我们没有遇到严重或危急的副作用和并发症。另一个好处是，即使在已经用抗淋巴细胞球蛋白和/或抗CD3单克隆抗体OKT3治疗过的患者中，DSG也能够逆转排斥反应发作。我们得出结论，DSG作为挽救疗法给药不会伴有严重副作用，并且对肾移植后的急性排斥反应最有效。
