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[肾移植后的生物治疗]

[Biological treatment following renal transplantation].

作者信息

Viklický O

机构信息

Klinika nefrologie, Transplantacní/centrum IKEM Praha.

出版信息

Vnitr Lek. 2011 Jul-Aug;57(7-8):650-3.

Abstract

Renal transplantation represents a method of choice in irreversible renal failure. The outcome of renal transplantation is affected by acute or chronic rejection and long-term evaluation also suggest a role of adverse effects of immunosuppressive therapy, mainly the incidence of cardiovascular complications and tumours. Immunosuppressive therapy with biologic agents aims to reduce the incidence of acute rejections, prolong allograft survival and, consequently, patient survival. Apart from a reduction in acute rejection incidence, biological agents are used in a selected group of patients to eliminate the need for an adjunctive treatment with steroids and to reduce consequences of ischemic-reperfusion damage in older donors who suffer from a range ofco-morbidities. The most frequently used therapies include induction and anti-rejection therapy with a rabbit polyclonal anti-human thymocyte globulin (rATG) or an induction therapy with monoclonal anti-interleukin-2 receptor antibody (anti-IL2R), basiliximab. Considering the high immunosuppressive effect of rATG, adverse effects, mainly opportunistic infections and more frequent delayed tumourigenesis, have to be taken into account.

摘要

肾移植是不可逆肾衰竭的首选治疗方法。肾移植的结果受急性或慢性排斥反应影响,长期评估还表明免疫抑制治疗的不良反应也起作用,主要是心血管并发症和肿瘤的发生率。使用生物制剂进行免疫抑制治疗旨在降低急性排斥反应的发生率,延长移植肾存活时间,从而提高患者生存率。除了降低急性排斥反应发生率外,生物制剂还用于特定患者群体,以消除使用类固醇辅助治疗的必要性,并减少患有多种合并症的老年供体缺血再灌注损伤的后果。最常用的治疗方法包括用兔抗人胸腺细胞球蛋白(rATG)进行诱导和抗排斥治疗,或用单克隆抗白细胞介素-2受体抗体(抗IL2R)巴利昔单抗进行诱导治疗。考虑到rATG的高免疫抑制作用,必须考虑其不良反应,主要是机会性感染和更频繁的延迟肿瘤发生。

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