Kim Peter T W, Chinnakotla Srinath, Davis Gary, Jennings Linda W, McKenna Greg J, Onaca Nicholas, Ruiz Richard M, Goldstein Robert, Levy Marlon F, Klintmalm Göran B
Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas. Dr. Kim is now a hepatobiliary fellow in Canada.
Proc (Bayl Univ Med Cent). 2011 Oct;24(4):287-94. doi: 10.1080/08998280.2011.11928740.
Different renal-sparing immunosuppressive protocols have been used in liver transplantation. At our institution, muromonab-CD3 (OKT3) is used in patients with acute renal failure (ARF), along with a delay in starting a calcineurin inhibitor. This study was conducted to compare outcomes in liver transplant patients with ARF who received OKT3 and those who did not. From 1988 to 2007, ARF was present in 1685 of 2587 patients (65%). OKT3 was used in 109 patients (OKT3 group). The control group (1416 patients) received a low-dose calcineurin inhibitor. The OKT3 group was more critically ill. In spite of this, the OKT3 group patients who were on renal replacement therapy (RRT) achieved long-term survival similar to that of the control group on RRT. Among the patients who were not on RRT, the OKT3 group had a higher complete recovery rate, but this did not translate into improved long-term survival. Bacterial and fungal infections were more common in the OKT3 group; however, there was no increased risk of malignancy or death from hepatitis C recurrence. The use of OKT3 in patients with ARF allowed more critically ill patients on RRT to achieve survival rates similar to those of patients who did not receive OKT3.
在肝移植中已采用了不同的肾保护免疫抑制方案。在我们机构，急性肾衰竭（ARF）患者使用鼠单克隆抗体-CD3（OKT3），同时延迟启动钙调神经磷酸酶抑制剂。本研究旨在比较接受OKT3的ARF肝移植患者与未接受OKT3的患者的结局。1988年至2007年，2587例患者中有1685例（65%）出现ARF。109例患者使用了OKT3（OKT3组）。对照组（1416例患者）接受低剂量钙调神经磷酸酶抑制剂。OKT3组病情更危重。尽管如此，接受肾脏替代治疗（RRT）的OKT3组患者的长期生存率与接受RRT的对照组相似。在未接受RRT的患者中，OKT3组的完全恢复率更高，但这并未转化为更好的长期生存率。OKT3组细菌和真菌感染更为常见；然而，丙型肝炎复发导致的恶性肿瘤或死亡风险并未增加。在ARF患者中使用OKT3使更多接受RRT的重症患者获得了与未接受OKT3的患者相似的生存率。
