Ghanekar A, Kashfi A, Cattral M, Selzner N, McGilvray I, Selzner M, Renner E, Lilly L, Levy G, Grant D, Greig P
University of Toronto Liver Transplant Program, Toronto General Hospital, Toronto, Ontario, Canada.
Transplant Proc. 2012 Jun;44(5):1351-6. doi: 10.1016/j.transproceed.2012.01.117.
Routine induction therapy in living donor liver transplantation (LDLT) has not been well described.
We reviewed outcomes of induction therapy with rabbit antithymocyte globulin (rATG) or basiliximab within 1 year of LDLT.
Between 2002 and 2007, 184 adults underwent LDLT and received induction therapy in addition to standard immunosuppression. Acute cellular rejection (ACR) developed in 17 of 130 patients (13.1%) who received rATG and 13 of 54 patients (24.1%) who received basiliximab (P = .066). The interval between transplantation and rejection as well as rejection severity was similar in patients who received rATG and those who received basiliximab. Hepatitis C (HCV) recurrence requiring initiation of antiviral therapy was more common in patients who received rATG compared with basiliximab (34.5% vs 8.7%; P = .021), and in those who received induction combined with tacrolimus as opposed to cyclosporine (38.5% vs 3.9%; P = .001). rATG and basiliximab were associated with excellent patient and graft survivals well as low rates of opportunistic infections and malignancies.
Induction with rATG or basiliximab was well tolerated and highly effective at preventing ACR within 1 year of LDLT, but may be associated with a higher risk of clinically significant HCV recurrence in some patients.
活体肝移植（LDLT）中的常规诱导治疗尚未得到充分描述。
我们回顾了LDLT术后1年内使用兔抗胸腺细胞球蛋白（rATG）或巴利昔单抗进行诱导治疗的结果。
2002年至2007年期间，184例成人接受了LDLT，并在标准免疫抑制基础上接受了诱导治疗。接受rATG的130例患者中有17例（13.1%）发生急性细胞排斥反应（ACR），接受巴利昔单抗的54例患者中有13例（24.1%）发生ACR（P = 0.066）。接受rATG和接受巴利昔单抗的患者在移植与排斥反应之间的间隔以及排斥反应严重程度相似。与接受巴利昔单抗的患者相比，接受rATG的患者中需要启动抗病毒治疗的丙型肝炎（HCV）复发更为常见（34.5%对8.7%；P = 0.021），在接受诱导治疗并联合使用他克莫司而非环孢素的患者中也是如此（38.5%对3.9%；P = 0.001）。rATG和巴利昔单抗与患者和移植物的良好存活率以及机会性感染和恶性肿瘤的低发生率相关。
rATG或巴利昔单抗诱导治疗耐受性良好，在LDLT术后1年内预防ACR非常有效，但在一些患者中可能与临床上显著的HCV复发风险较高有关。
