Padiyar Aparna, Augustine Joshua J, Hricik Donald E
Department of Medicine, University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH 44106, USA.
Am J Kidney Dis. 2009 Nov;54(5):935-44. doi: 10.1053/j.ajkd.2009.06.020. Epub 2009 Aug 14.
Antilymphocyte antibodies have been used for the prevention or treatment of acute rejection in kidney transplant recipients since the 1960s. Both monoclonal and polyclonal agents now are available and generally are classified as either lymphocyte-depleting or nondepleting agents. Use of such antibodies for induction therapy in the immediate postoperative period has varied over the years. Currently, induction antibodies are administered to more than 70% of kidney transplant recipients in the United States. However, the choice of specific agents and the patients for whom they are used vary substantially between and within transplant centers. Many centers use antibody induction therapy only in patients perceived to be at high risk of acute rejection or delayed graft function. Recently, induction antibody therapy also has become the standard of practice in protocols designed to facilitate minimization of such maintenance immunosuppressive drugs as corticosteroids or calcineurin inhibitors. The benefits of induction therapy, including a decreased incidence and delayed onset of acute rejection, must be balanced against the considerable cost and side effects of the individual agents, including risk of infection. Some, but not all, antibodies are associated with increased risk of posttransplantation lymphoproliferative disease and other malignancies.
自20世纪60年代以来，抗淋巴细胞抗体一直用于预防或治疗肾移植受者的急性排斥反应。目前既有单克隆制剂也有多克隆制剂，它们通常分为淋巴细胞清除剂或非清除剂。多年来，这类抗体在术后即刻用于诱导治疗的情况有所不同。目前，美国超过70%的肾移植受者会使用诱导抗体。然而，具体制剂的选择以及使用这些制剂的患者在不同移植中心之间以及同一移植中心内部都存在很大差异。许多中心仅在被认为有急性排斥反应或移植肾功能延迟风险高的患者中使用抗体诱导治疗。最近，在旨在尽量减少皮质类固醇或钙调神经磷酸酶抑制剂等维持性免疫抑制药物使用的方案中，诱导抗体治疗也已成为标准做法。诱导治疗的益处，包括急性排斥反应发生率降低和发病延迟，必须与各制剂相当高的成本和副作用（包括感染风险）相权衡。一些（但不是全部）抗体与移植后淋巴细胞增生性疾病和其他恶性肿瘤的风险增加有关。
