Hancke E, Schleibner S, Schneeberger H, Illner W D, Land W
Abteilung für Transplantationschirurgie, Klinikum Grosshadern der Universität München.
Dtsch Med Wochenschr. 1990 Mar 23;115(12):443-6. doi: 10.1055/s-2008-1065027.
To determine, whether the infection rate after renal transplantation is influenced by the intensity of immunosuppressive treatment, the postoperative course of 100 consecutive renal transplantations in 64 men and 36 women (mean age 44.1 [18-72] years) was investigated prospectively. 87 patients received threefold basal immunosuppression with low-dose ciclosporin, azathioprine and prednisolone. In 13 risk patients (retransplantation and [or] high panel-reactive antibody titres), poly- or monoclonal antibodies were administered additionally to prevent rejection. Steroid-resistant rejection crises had to be treated with poly- or monoclonal antibodies in 15 patients. Postoperatively there were 10 patients with systemic infections (5 with cytomegalovirus, 4 with herpes simplex virus and 1 with Pneumocystis carinii). The infection rate with three- or fourfold immunosuppression did not differ significantly (5.4% vs. 9.1%). However, infections occurred more frequently after additional antirejection treatment with poly- or monoclonal antibodies (33%). It is concluded from these results that fourfold basal immunosuppression treatment with poly- or monoclonal antibodies is not associated with an increased risk of perioperative infections.
为了确定肾移植后的感染率是否受免疫抑制治疗强度的影响，我们对64名男性和36名女性（平均年龄44.1岁[18 - 72岁]）连续进行的100例肾移植患者的术后病程进行了前瞻性研究。87例患者接受了低剂量环孢素、硫唑嘌呤和泼尼松龙的三联基础免疫抑制治疗。13例高危患者（再次移植和/或高群体反应性抗体滴度）额外给予了多克隆或单克隆抗体以预防排斥反应。15例患者出现类固醇抵抗性排斥反应危机，必须用多克隆或单克隆抗体进行治疗。术后有10例患者发生全身感染（5例为巨细胞病毒感染，4例为单纯疱疹病毒感染，1例为卡氏肺孢子虫感染）。三联或四联免疫抑制治疗的感染率无显著差异（5.4%对9.1%）。然而，在额外使用多克隆或单克隆抗体进行抗排斥治疗后，感染更频繁发生（33%）。从这些结果得出结论，使用多克隆或单克隆抗体进行四联基础免疫抑制治疗与围手术期感染风险增加无关。
