Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada.
Am J Transplant. 2011 Jan;11(1):163-8. doi: 10.1111/j.1600-6143.2010.03348.x.
Successful clinical islet allotransplantation requires control of both allo- and autoimmunity by using immunosuppressant drugs which have a number of side effects. The development of the autoimmune condition alopecia areata following successful islet transplantation is therefore unexpected. Three cases of alopecia affecting female islet transplant recipients are described. In all cases, alopecia developed approximately 7 years after initial transplant. All had received daclizumab, sirolimus and tacrolimus with their initial transplants, but all were receiving a combination of tacrolimus and mycophenolate mofetil at the time alopecia developed. Two subjects had received thymoglobulin for a subsequent islet infusion and prior to the onset of alopecia. The progression of alopecia has been halted or reversed in all cases. Tacrolimus has been continued in two cases (one as monotherapy) while cyclosporine was used in place of tacrolimus in the third case. These three cases represent a crude incidence of <2.5% over 5 years compared with a prevalence of alopecia in islet transplant candidates (pretransplant) of <1%. Although alopecia might be expected in a proportion of individuals with type 1 diabetes, the risk may be increased after islet transplantation, and may be associated with the use of anti-TNF drugs, lymphodepleting antibodies or higher dose tacrolimus.
成功的临床胰岛同种异体移植需要通过使用免疫抑制剂药物来控制同种异体和自身免疫，这些药物有许多副作用。因此，在成功的胰岛移植后出现斑秃等自身免疫性疾病是出乎意料的。本文描述了 3 例影响女性胰岛移植受者的脱发病例。在所有病例中，脱发均在初始移植后约 7 年发生。所有患者在初始移植时均接受了达利珠单抗、西罗莫司和他克莫司，而在脱发发生时均接受了他克莫司和吗替麦考酚酯的联合治疗。其中 2 例患者在发生脱发前曾接受过胸腺球蛋白的胰岛输注。所有病例的脱发进展均已停止或逆转。在 2 例病例中继续使用他克莫司（其中 1 例为单药治疗），而在第 3 例病例中则用环孢素替代他克莫司。这 3 例病例在 5 年内的发生率<2.5%，而胰岛移植候选者（移植前）的脱发患病率<1%。尽管在 1 型糖尿病患者中，脱发可能在一定比例的个体中出现，但在胰岛移植后，风险可能会增加，并且可能与使用抗 TNF 药物、淋巴细胞耗竭抗体或更高剂量的他克莫司有关。
