Jonsson J, Light J A, Korb S M
Washington Hospital Center, Transplant Service, D.C.
Clin Transpl. 1990:275-88.
These data demonstrate excellent long-term patient and graft survival rates when cytolytic induction therapy is combined with sequential addition of CsA. OKT3 and MAG produce virtually indistinguishable outcomes with low rates of rejection and DGF. The frequency of serious posttransplant complications, infection, rejection, and malignancy was low. Although both MAG and OKT3 are effective, each has its drawbacks. Problems associated with MAG therapy are leukopenia, thrombocytopenia, cumbersome administration, and difficulty monitoring the patient's specific level of induced immunosuppression. OKT3 is simpler to administer, easy to monitor, but first dose reactions may produce additional graft injury. Furthermore, OKT3 may not protect completely against all mechanisms of cellular rejection. In our patient population, the best results occurred when kidneys functioned immediately, when CsA was introduced promptly, and when there were several days of overlap, with MAG or OKT3, especially when OKT3 was used as the induction agent.
这些数据表明，当细胞溶解诱导疗法与序贯添加环孢素A（CsA）相结合时，患者和移植物的长期存活率极佳。OKT3和莫罗单抗-CD3（MAG）产生的结果几乎无法区分，排斥反应和延迟性移植物功能不全（DGF）发生率很低。移植后严重并发症、感染、排斥反应和恶性肿瘤的发生率较低。虽然MAG和OKT3都有效，但各有其缺点。与MAG治疗相关的问题有白细胞减少、血小板减少、给药繁琐以及难以监测患者诱导免疫抑制的具体水平。OKT3给药更简单，易于监测，但首剂反应可能会对移植物造成额外损伤。此外，OKT3可能无法完全预防细胞排斥反应的所有机制。在我们的患者群体中，当肾脏立即发挥功能、及时引入CsA以及与MAG或OKT3有几天重叠使用时，尤其是当使用OKT3作为诱导剂时，会取得最佳结果。
