Division of Transplantation, Department of Surgery, The Pennsylvania State University, College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
Transplantation. 2011 Sep 27;92(6):678-85. doi: 10.1097/TP.0b013e31822b58be.
The use of alemtuzumab (humanized anti-CD52 monoclonal antibody) has been primarily studied in renal transplantation, and the experience of alemtuzumab induction in pancreas transplantation is still limited. The objective of this study is to analyze the outcome of pancreas transplantation by using a single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression.
We performed a total 28 pancreas transplants (17 simultaneous kidney-pancreas transplantation [SPK], 5 pancreas after kidney transplantation [PAK], and 6 pancreas transplant alone [PTA]) between November 2006 and April 2010. Median follow-up was 25 months (range, 8-49 months). Maintenance immunosuppression consists of tacrolimus and mycophenolate. We analyzed patient/graft survival, graft function, and complications.
One-year actuarial patient/graft survival was 100%/100% in SPK, PAK, and PTA. Three-year actuarial patient/pancreas graft survival rates for SPK, PAK, and PTA were 100%/100%, 100%/100%, and 100%/83%, respectively. Excellent pancreas and kidney graft functions were observed. Acute cellular rejection occurred in 42% of patients. Most of the rejection episode occurred approximately 1 or 6 months after transplant. Absolute lymphocyte count remained below preoperative level for 1 year posttransplant and WBC counts were significantly lower for 3 years after transplant compared with pretransplant level. Cytomegalovirus infection and bacterial infection occurred in 28% and 36% of patients, respectively. Eleven percent of patients developed donor-specific antibodies and 7% of patients experienced antibody-mediated rejection.
A single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression achieved excellent mid-term patient and graft survival for pancreas transplantation with acceptable complication rate.
阿仑单抗（人源化抗 CD52 单克隆抗体）的应用主要在肾移植中进行了研究，而在胰腺移植中应用阿仑单抗诱导的经验仍然有限。本研究的目的是分析单次使用 30mg 阿仑单抗诱导并进行无类固醇维持免疫抑制治疗的胰腺移植结果。
我们在 2006 年 11 月至 2010 年 4 月期间共进行了 28 例胰腺移植（17 例同时肾胰腺移植 [SPK]，5 例肾移植后胰腺移植 [PAK]，6 例单纯胰腺移植 [PTA]）。中位随访时间为 25 个月（范围，8-49 个月）。维持免疫抑制包括他克莫司和霉酚酸酯。我们分析了患者/移植物存活率、移植物功能和并发症。
SPK、PAK 和 PTA 的 1 年实际患者/移植物存活率为 100%/100%。SPK、PAK 和 PTA 的 3 年实际患者/胰腺移植物存活率分别为 100%/100%、100%/100%和 100%/83%。观察到胰腺和肾脏移植物功能良好。发生急性细胞排斥反应的患者占 42%。大多数排斥反应发生在移植后 1 个月或 6 个月左右。移植后 1 年，绝对淋巴细胞计数仍低于术前水平，白细胞计数在移植后 3 年较术前水平显著降低。发生巨细胞病毒感染和细菌感染的患者分别占 28%和 36%。11%的患者产生了供体特异性抗体，7%的患者发生了抗体介导的排斥反应。
单次使用 30mg 阿仑单抗诱导并进行无类固醇维持免疫抑制治疗，可实现胰腺移植的中期患者和移植物存活率良好，并发症发生率可接受。
