Ferrer F, Machado S, Alves R, Macário F, Bastos C, Roseiro A, Mota A
Renal Transplantation Unit, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Transplant Proc. 2010 Mar;42(2):467-70. doi: 10.1016/j.transproceed.2010.01.039.
The use of monoclonal antibodies in renal transplantation for induction therapy has been associated with a marked reduction in acute rejection rates with an impact on graft and patient survivals.
We sought to evaluate the efficacy of renal transplant induction protocols using Basiliximab based on the rates of acute rejection episodes (ARE) and delayed graft function (DGF) of infectious complications in the first 6 months posttransplant, as well as patient and graft survivals.
We retrospectively evaluated all renal transplants performed between 2000 and 2008 that were primary grafts from cadaveric heart-beating donors, into recipients with a panel reactive antibody titer <5% and who were treated with an immunosuppression scheme based on cyclosporine, mycophenolate mofetil/mycophenolic acid plus corticosteroids, with (group 1) or without basiliximab (group 2).
We enrolled 52 recipients in group 1 (induction with basiliximab) and 189 in group 2 (without basiliximab). The baseline characteristics were similar among the groups, except for time on dialysis which was longer in group 1 and the number of HLA matches, which was lower in group 1. The ARE rate was lower among group 1 (7.8% vs 27.8%; P = .001); rates of DGF and infectious complications were similar. There was no significant difference in graft and patient survivals.
In this study, induction with basiliximab was associated with a reduced rate rate of ARE, despite a lower number of HLA matches and a longer previous time on dialysis. The use of this induction modality was not associated with a greater rate of infectious complications.
在肾移植诱导治疗中使用单克隆抗体与急性排斥反应率显著降低相关，这对移植物和患者存活产生了影响。
我们试图根据移植后前6个月的急性排斥反应发作率（ARE）、移植肾功能延迟恢复（DGF）以及感染并发症发生率，评估使用巴利昔单抗的肾移植诱导方案的疗效，同时评估患者和移植物的存活率。
我们回顾性评估了2000年至2008年间进行的所有肾移植，这些移植均为来自尸体心脏跳动供体的初次移植物，受体的群体反应性抗体滴度<5%，并接受了基于环孢素、霉酚酸酯/霉酚酸加皮质类固醇的免疫抑制方案治疗，其中一组（第1组）使用巴利昔单抗，另一组（第2组）未使用。
第1组（使用巴利昔单抗诱导）纳入52例受体，第2组（未使用巴利昔单抗）纳入189例受体。除第1组透析时间较长且HLA配型数量较少外，两组的基线特征相似。第1组的ARE发生率较低（7.8%对27.8%；P = 0.001）；DGF和感染并发症发生率相似。移植物和患者存活率无显著差异。
在本研究中，尽管HLA配型数量较少且先前透析时间较长，但使用巴利昔单抗诱导与ARE发生率降低相关。这种诱导方式的使用与更高的感染并发症发生率无关。
