Meier-Kriesche H-U, Li S, Gruessner R W G, Fung J J, Bustami R T, Barr M L, Leichtman A B
University of Florida, Gainesville, FL, USA.
Am J Transplant. 2006;6(5 Pt 2):1111-31. doi: 10.1111/j.1600-6143.2006.01270.x.
Over the last 10 years, there have been important changes in immunosuppression management and strategies for solid-organ transplantation, characterized by the use of new immunosuppressive agents and regimens. An organ-by-organ review of OPTN/SRTR data showed several important trends in immunosuppression practice. There is an increasing trend toward the use of induction therapy with antibodies, which was used for most kidney, pancreas after kidney (PAK), simultaneous pancreas-kidney (SPK) and pancreas transplant alone (PTA) recipients in 2004 (72-81%) and for approximately half of all intestine, heart and lung recipients. The highest usage of the tacrolimus/mycophenolate mofetil combination as discharge regimen was reported for SPK (72%) and PAK (64%) recipients. Maintenance of the original discharge regimen through the first 3 years following transplantation varied significantly by organ and drug. The usage of calcineurin inhibitors for maintenance therapy was characterized by a clear transition from cyclosporine to tacrolimus. Corticosteroids were administered to the majority of patients; however, steroid-avoidance and steroid-withdrawal protocols have become increasingly common. The percentage of patients treated for acute rejection during the first year following transplantation has continued to decline, reaching 13% for those who received a kidney in 2003, 48% of which cases were treated with antibodies.
在过去10年中，实体器官移植的免疫抑制管理和策略发生了重大变化，其特点是使用了新的免疫抑制剂和方案。对器官获取与移植网络（OPTN）/器官共享联合网络（SRTR）数据进行的逐个器官审查显示了免疫抑制实践中的几个重要趋势。使用抗体进行诱导治疗的趋势在增加，2004年大多数肾、肾后胰腺（PAK）、胰肾联合移植（SPK）和单纯胰腺移植（PTA）受者使用了该治疗方法（72%-81%），约一半的小肠、心脏和肺移植受者也使用了该方法。据报告，作为出院方案，他克莫司/霉酚酸酯联合用药在SPK受者（72%）和PAK受者（64%）中的使用比例最高。移植后前3年维持原出院方案的情况因器官和药物不同而有显著差异。用于维持治疗的钙调神经磷酸酶抑制剂的使用特点是明显从环孢素过渡到他克莫司。大多数患者接受了皮质类固醇治疗；然而，避免使用类固醇和撤减类固醇方案已变得越来越普遍。移植后第一年接受急性排斥反应治疗的患者比例持续下降，2003年接受肾移植的患者中这一比例降至13%，其中48%的病例使用抗体进行治疗。
