Stratta R J, Sundberg A K, Farney A C, Rohr M S, Hartmann E L, Adams P L
Dept. of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157-1095, USA.
Transplant Proc. 2005 Oct;37(8):3546-8. doi: 10.1016/j.transproceed.2005.09.084.
The purpose of this study was to retrospectively review outcomes in patients undergoing pancreas transplantation (PTX) with a novel induction protocol of alternate-day thymoglobulin (rATG) in combination with tacrolimus (TAC), mycophenolate mofetil (MMF), and steroids. From January 2002 through January 2005, we performed 55 PTXs in 53 patients. The first dose of rATG (1.5 mg/kg) was given intraoperatively, and subsequent doses were given on alternate days until therapeutic TAC levels (>8 ng/mL) were achieved. All patients underwent PTX with enteric drainage, including 51 with portal and 4 with systemic venous drainage. Patients received a minimum of 2 and maximum of 6 doses of rATG induction (median 3 doses). The patient group had a mean age of 42.8 years and included 40 simultaneous kidney-PTX, 11 sequential PTX after kidney, and 4 PTX-alone transplant recipients. Patient, kidney, and pancreas graft survival rates are 96%, 96%, and 84%, respectively, with a mean follow-up of 21 months. The incidence of acute rejection was 18%; there were no graft losses due to isolated acute rejection. The incidence of infection was 60%, but there were no cases of polyomavirus or Epstein-Barr virus infection and only 6 cases (11%) of cytomegalovirus infection. The composite endpoint of no rejection, graft loss, or mortality was attained by 71% of patients. At present, 94% of surviving patients are both dialysis and insulin-free, including 5 successful PTX retransplants. These findings suggest that PTX with portal-enteric drainage and alternate day rATG induction may result in excellent intermediate-term outcomes.
本研究的目的是回顾性分析采用新型诱导方案（隔日使用抗胸腺细胞球蛋白[rATG]联合他克莫司[TAC]、霉酚酸酯[MMF]和类固醇）进行胰腺移植（PTX）的患者的预后情况。2002年1月至2005年1月，我们对53例患者实施了55次PTX。rATG的首剂（1.5mg/kg）在术中给予，随后剂量隔日给予，直至达到治疗性TAC水平（>8ng/mL）。所有患者均接受了肠内引流的PTX，其中51例采用门静脉引流，4例采用体静脉引流。患者接受rATG诱导的剂量最少2剂、最多6剂（中位数为3剂）。患者组的平均年龄为42.8岁，包括40例同期肾-胰腺移植、11例肾移植后序贯胰腺移植以及4例单纯胰腺移植受者。患者、肾和胰腺移植物的生存率分别为96%、96%和84%，平均随访时间为21个月。急性排斥反应的发生率为18%；未发生因单纯急性排斥反应导致的移植物丢失。感染发生率为60%，但未发生多瘤病毒或EB病毒感染病例，仅6例（11%）发生巨细胞病毒感染。71%的患者达到了无排斥反应、无移植物丢失或无死亡的复合终点。目前，94%的存活患者已停止透析且无需使用胰岛素，其中包括5例成功的PTX再次移植。这些研究结果表明，采用门静脉-肠内引流和隔日rATG诱导的PTX可能会带来出色的中期预后。
