Cai Junchao, Terasaki Paul I
Terasaki Foundation Laboratory, Los Angeles, CA, USA.
Clin Transpl. 2010:45-52.
We investigate the status of sensitization in kidney transplant recipients and analyze the trend of induction and maintenance therapy in patients of different PRA levels. Despite the fact of the decreased percentages of kidney transplant recipients with presensitization history, the mean PRA levels of all kidney recipients has been increasing in the last 7 years, which is possibly due to the introduction of more sensitive antibody testing techniques or the tendency for kidney allocation organization and clinicians to give priority to patients with elevated PRA once a compatible donor kidney becomes available. The percentage of patients with treated rejection episodes within one year post-transplant were significantly higher in sensitized patients (PRA = 50-100:14.3%, and PRA = 1-49%: 13.9%) than in non-sensitized patients (12.4%). Both 1- and 5-yr graft survival rates have improved in the last 10 years; this was more significant in high PRA patients. Thymoglobulin was the most commonly used induction agent in last 10 years. Its users increased from 10% to 46% in non-sensitized patients, from 12% to 57% in PRA = 1-49% patients, and from 19% to 63% in PRA = 50-100% patients. The users of Campath, IVIg, and Rituximab have been increasing and reached 16%, 20%, and 11% in highly sensitized patients. In the last 5 years, steroid-free patients were 33-36%, 30-37%, and 10-25% for patients with PRA levels of 0, 1-49, and 50-100 respectively. Almost 90% of patients were on Prograf at discharge. Myfortic users have been increasing since 2005 and it may soon replace MMF if long-term follow-up study confirms its safety and efficacy.
我们调查了肾移植受者的致敏状态，并分析了不同群体反应性抗体（PRA）水平患者的诱导和维持治疗趋势。尽管有预致敏史的肾移植受者百分比有所下降，但在过去7年中，所有肾移植受者的平均PRA水平一直在上升，这可能是由于采用了更敏感的抗体检测技术，或者是肾脏分配机构和临床医生倾向于在有合适的供肾时优先考虑PRA升高的患者。致敏患者（PRA = 50 - 100：14.3%，PRA = 1 - 49%：13.9%）移植后一年内发生治疗性排斥反应的患者百分比显著高于非致敏患者（12.4%）。在过去10年中，1年和5年移植肾存活率均有所提高；这在高PRA患者中更为显著。过去10年中，胸腺球蛋白是最常用的诱导剂。其在非致敏患者中的使用率从10%增至46%，在PRA = 1 - 49%的患者中从12%增至57%，在PRA = 50 - 100%的患者中从19%增至63%。Campath、静脉注射免疫球蛋白（IVIg）和利妥昔单抗的使用者一直在增加，在高度致敏患者中分别达到16%、20%和11%。在过去5年中，PRA水平为0、1 - 49和50 - 100的患者中，无类固醇治疗的患者分别为33 - 36%、30 - 37%和10 - 25%。出院时近90%的患者使用他克莫司。自2005年以来，米芙的使用者一直在增加，如果长期随访研究证实其安全性和有效性，它可能很快取代霉酚酸酯（MMF）。
