Sundberg A K, Roskopf J A, Hartmann E L, Farney A C, Rohr M S, Stratta R J
Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157-1095, USA.
Transplant Proc. 2005 Mar;37(2):1294-6. doi: 10.1016/j.transproceed.2004.12.070.
This study evaluates our initial experience using alemtuzumab induction with rapid corticosteroid elimination in kidney (KTX) and pancreas transplant (PTX) patients. Data were collected retrospectively for all patients who received single-dose alemtuzumab (30 mg IV intraoperatively) with steroid pretreatment and a control group who received alternate day rabbit antithymocyte globulin (rATG) induction with a steroid-based regimen. Patients in both groups received tacrolimus (TAC) and mycophenolate mofetil (MMF). There were 16 patients in each group, including 9 deceased donor KTXs, 5 living donor KTXs, 1 simultaneous K-PTX, and 1 sequential PTX after KTX. Demographic, immunologic, and transplant characteristics were similar between groups. Nine patients (56%) in the alemtuzumab group compared to five (25%) in the control group developed neutropenia requiring MMF or valganciclovir dose reduction (or both). Absolute lymphocyte counts at 3 months were 340 +/- 200/mm3 and 890 +/- 544/ mm3 in the alemtuzumab and control groups, respectively (P = .001). There were two biopsy-proven acute rejection episodes (12.5%) in each group, and no difference in the incidence of infection. Creatinine clearance at 6 months was 58 mL/min in each group. Patient and kidney graft survival rates were both 94% in the alemtuzumab group (one death from cardiac arrest), compared with 100% patient and kidney graft survival rates in the control group (P = NS), with a mean follow-up of 9 and 11 months, respectively. The results of this pilot study suggest that similar short-term outcomes can be achieved using a rapid steroid elimination protocol with alemtuzumab induction therapy compared to rATG with steroids in patients receiving TAC and MMF maintenance therapy.
本研究评估了我们在肾移植（KTX）和胰腺移植（PTX）患者中使用阿仑单抗诱导联合快速糖皮质激素清除的初步经验。回顾性收集了所有接受单剂量阿仑单抗（术中静脉注射30 mg）并进行激素预处理的患者以及接受隔日兔抗胸腺细胞球蛋白（rATG）诱导并采用基于激素方案的对照组的数据。两组患者均接受他克莫司（TAC）和霉酚酸酯（MMF）治疗。每组有16例患者，包括9例死亡供体肾移植、5例活体供体肾移植、1例同期肾 - 胰腺移植以及1例肾移植后序贯胰腺移植。两组患者的人口统计学、免疫学和移植特征相似。阿仑单抗组有9例患者（56%）出现中性粒细胞减少，需要减少MMF或缬更昔洛韦剂量（或两者都减少），而对照组为5例（25%）。阿仑单抗组和对照组在3个月时的绝对淋巴细胞计数分别为340±200/mm³和890±544/mm³（P = 0.001）。每组均有2例经活检证实的急性排斥反应（12.5%），感染发生率无差异。6个月时每组的肌酐清除率均为58 mL/min。阿仑单抗组的患者和肾移植存活率均为94%（1例死于心脏骤停），而对照组的患者和肾移植存活率均为100%（P = 无显著性差异），平均随访时间分别为9个月和11个月。这项初步研究的结果表明，在接受TAC和MMF维持治疗的患者中，与使用rATG联合激素治疗相比，采用阿仑单抗诱导治疗的快速激素清除方案可实现相似的短期疗效。
