Laske A, Gallino A, Schneider J, Bauer E P, Carrel T, Pasic M, von Segesser L K, Turina M I
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
J Heart Lung Transplant. 1992 May-Jun;11(3 Pt 1):557-63.
The value of immunoprophylaxis with monoclonal anti-CD3 antibodies (OKT3) was evaluated in 44 consecutive, nonrandomized heart transplant patients. The control group (n = 22) was treated with polyclonal rabbit antithymocyte globulin (RATG) for 5 days. The study group (n = 22) was treated with OKT3 for 14 days. All patients had identical perioperative immunosuppressive therapy and similar maintenance therapy, with cyclosporine, azathioprine, and low-dose prednisone (starting prednisone: OKT3 group immediately, RATG group 3 weeks [n = 11] or greater than 3 months [n = 11] after transplantation). The mean histologic rejection grade (Texas classification) in the RATG and the OKT3 groups was 2.5 +/- 1.9 and 0.6 +/- 0.8 (p less than 0.005) after 1 week and 4.3 +/- 1.6 and 2.0 +/- 1.5 (p less than 0.001) after 2 weeks, but there was no difference in the first year. The linearized rejection rate (rejections per 100 patient days) was higher in the RATG group in the first 2 weeks (2.6 vs 0, p less than 0.05 respectively, 7.8 vs 0.7, p less than 0.001) and higher in the OKT3 group in the second month (1.4 vs 2.8, p less than 0.01). In the RATG group the rejection rate fell continuously, to 0.1 at the end of the first year, whereas in the OKT3 group it remained 0.4 (NS). The cumulative first-year incidence was similar for persistent rejections (RATG 0.38 +/- 0.29 vs OKT3 0.48 +/- 1.13, NS) and insignificantly higher for severe rejections in the OKT3 group (RATG 0.21 +/- 0.32 vs OKT3 0.49 +/- 1.10). Rejection-related mortality in the first year was 0% (RATG) and 9% (OKT3).(ABSTRACT TRUNCATED AT 250 WORDS)
在44例连续的、非随机分组的心脏移植患者中评估了单克隆抗CD3抗体（OKT3）免疫预防的价值。对照组（n = 22）接受多克隆兔抗胸腺细胞球蛋白（RATG）治疗5天。研究组（n = 22）接受OKT3治疗14天。所有患者均接受相同的围手术期免疫抑制治疗和相似的维持治疗，使用环孢素、硫唑嘌呤和低剂量泼尼松（开始使用泼尼松：OKT3组立即使用，RATG组在移植后3周[n = 11]或大于3个月[n = 11]使用）。RATG组和OKT3组在1周后的平均组织学排斥分级（德克萨斯分类）分别为2.5±1.9和0.6±0.8（p<0.005），2周后分别为4.3±1.6和2.0±1.5（p<0.001），但在第一年没有差异。在前2周，RATG组的线性化排斥率（每100患者日的排斥次数）更高（分别为2.6对0，p<0.05；7.8对0.7，p<0.001），在第二个月OKT3组更高（1.4对2.8，p<0.01）。在RATG组中，排斥率持续下降，在第一年末降至0.1，而在OKT3组中仍为0.4（无显著性差异）。持续性排斥的累积第一年发生率相似（RATG为0.38±0.29对OKT3为0.48±1.13，无显著性差异），OKT3组严重排斥的发生率略高（RATG为0.21±0.32对OKT3为0.49±1.10）。第一年与排斥相关的死亡率，RATG组为0%，OKT3组为9%。（摘要截短至250字）
