Lee B M, Oh C K, Jin S H, Kim J H, Kim S J, Kim H, Shin G T
Department of Surgery, Ajou University School of Medicine, 5 Wonshon-Dong, Yeongtong-Gu, Suwon 443-721, Korea.
Transplant Proc. 2006 Sep;38(7):2025-8. doi: 10.1016/j.transproceed.2006.06.026.
Basiliximab is widely used in clinical practice for initial immunosuppressive treatment of renal transplant recipients, seeking to reduce the incidence of acute rejection episodes without adverse events. This retrospective study included 123 renal allograft recipients transplanted at a single center. All were followed for longer than 1 year after transplantation and treated with calcineurin inhibitor and steroid (methylprednisolone) for prophylactic immunosuppression, but basiliximab and mycophenolate mofetil were optional. We compared the outcomes of renal transplant recipients who were versus treated were not with basiliximab as initial immunosuppressive therapy. Basiliximab was used for initial immunosuppression in 42 patients. Their maintenance immunosuppressive treatment included triple (n = 44) or double (n = 79) regimens, including a calcineurin inhibitor (cyclosporine [n = 87] or tacrolimus [n = 36]), methylprednisolone with or without mycophenolate mofetil. Twenty-six (21.1%) patients had a rejection episode within 1 year after transplantation and 22 (17.9%) had infections. Within the first year after transplantation the patients who were treated with basiliximab showed fewer rejection episodes (n = 6, 14.3%) than the patients without this therapy (n = 20, 24.7%), which was not statistically significant (P = .245). However, basiliximab significantly affected the occurrence of rejection episodes among the double immunosuppressive regimen group (P = .006), but not the triple regimen group (P = .098) without an impact on infection episodes (P value of double, triple = .291, .414) within 1 year after transplantation. We concluded that basiliximab was more useful for the recipients treated with double immunosuppression with a calcineurin inhibitor and steroid than for those on a triple regimen including mycophenolate mofetil.
巴利昔单抗广泛应用于临床实践中，用于肾移植受者的初始免疫抑制治疗，旨在降低急性排斥反应的发生率且无不良事件。这项回顾性研究纳入了在单一中心接受移植的123例同种异体肾移植受者。所有患者移植后均随访超过1年，并接受钙调神经磷酸酶抑制剂和类固醇（甲泼尼龙）进行预防性免疫抑制治疗，但巴利昔单抗和霉酚酸酯为可选药物。我们比较了接受与未接受巴利昔单抗作为初始免疫抑制治疗的肾移植受者的结局。42例患者使用巴利昔单抗进行初始免疫抑制。他们的维持免疫抑制治疗包括三联（n = 44）或双联（n = 79）方案，包括钙调神经磷酸酶抑制剂（环孢素[n = 87]或他克莫司[n = 36]）、甲泼尼龙，有或没有霉酚酸酯。26例（21.1%）患者在移植后1年内发生排斥反应，22例（17.9%）发生感染。在移植后的第一年内，接受巴利昔单抗治疗的患者发生排斥反应的次数（n = 6，14.3%）少于未接受该治疗的患者（n = 20，24.7%），但差异无统计学意义（P = 0.245）。然而，巴利昔单抗显著影响双联免疫抑制方案组中排斥反应的发生（P = 0.006），但对三联方案组无显著影响（P = 0.098），且对移植后1年内的感染次数无影响（双联、三联方案组的P值分别为0.291、0.414）。我们得出结论，对于接受钙调神经磷酸酶抑制剂和类固醇双联免疫抑制治疗的受者，巴利昔单抗比对于包括霉酚酸酯的三联方案受者更有用。
