Ramirez C B, Doria C, di Francesco F, Iaria M, Kang Y, Marino I R
Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Transplant Proc. 2006 Dec;38(10):3633-5. doi: 10.1016/j.transproceed.2006.10.110.
Induction with the use of interleukin-2 receptor monoclonal antibodies may avoid many of the adverse events associated with polyclonal antibodies and significantly impact on rejection-free long-term survival in orthotopic liver transplantation (OLTx). We describe our experience with the use of basiliximab induction therapy in adult OLTx recipients on tacrolimus-based immunosuppression. Forty-six consecutive deceased donor primary OLTx were analyzed. All patients received standard doses of basiliximab, tacrolimus, and steroids. Mycophenolate mofetil was also used as indicated. The mean follow-up period was 17.9 months. Forty-three patients remained rejection-free during follow-up. The actuarial patient and graft survival rate at 2 years was 93%. The rate of histology-proven hepatitis C virus (HCV) recurrence was 24%, with two progressing to severe cholestatic recurrent HCV. None of the study patients developed (cytomegalovirus (CMV) infection or posttransplant lymphoproliferative disease (PTLD). Results were compared to a historical group of 46 OLTx recipients on tacrolimus-based immunosuppression without basiliximab induction. The historical group had a rejection rate of 34% with lower patient and graft survival rates of 71.74% and 69.5%, respectively, at 24 months as well as a higher histological HCV recurrence rate of 77% (17/22), with three patients progressing to graft failure within 2 years. CMV infection and disease developed in 4.5% of the patients. Although PTLD was not observed, three recipients with hepatocellular carcinoma (HCC) developed and died of metastatic HCC. Induction with basiliximab in combination with tacrolimus-based immunosuppressive regimen reduces the incidence of rejection and improves rejection-free survival rate after OLTx without increasing the incidence of CMV, PTLD, or HCV recurrence.
使用白细胞介素-2受体单克隆抗体进行诱导治疗可避免许多与多克隆抗体相关的不良事件，并对原位肝移植（OLTx）无排斥反应的长期生存产生显著影响。我们描述了在接受基于他克莫司的免疫抑制治疗的成年OLTx受者中使用巴利昔单抗诱导治疗的经验。分析了46例连续的脑死亡供体原发性OLTx。所有患者均接受标准剂量的巴利昔单抗、他克莫司和类固醇。必要时也使用霉酚酸酯。平均随访期为17.9个月。43例患者在随访期间无排斥反应。2年时患者和移植物的精算生存率为93%。经组织学证实的丙型肝炎病毒（HCV）复发率为24%，其中2例进展为严重胆汁淤积性复发性HCV。研究患者均未发生巨细胞病毒（CMV）感染或移植后淋巴细胞增生性疾病（PTLD）。将结果与46例接受基于他克莫司的免疫抑制治疗但未使用巴利昔单抗诱导的OLTx受者的历史队列进行比较。历史队列的排斥率为34%，24个月时患者和移植物生存率较低，分别为71.74%和69.5%，组织学HCV复发率较高，为77%（17/22），3例患者在2年内进展为移植物衰竭。4.5%的患者发生了CMV感染和疾病。虽然未观察到PTLD，但3例肝细胞癌（HCC）受者发生并死于转移性HCC。巴利昔单抗联合基于他克莫司的免疫抑制方案进行诱导治疗可降低OLTx后排斥反应的发生率，并提高无排斥反应的生存率，且不增加CMV、PTLD或HCV复发的发生率。
