Institute of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
Transplantation. 2013 May 27;95(10):1197-203. doi: 10.1097/TP.0b013e31828bca61.
The use of topical immunosuppressants has been anecdotally reported for the treatment of rejection in vascularized composite allotransplantation. The aim of this study was to evaluate the effectiveness of topical tacrolimus and clobetasol in the prevention and treatment of rejection.
Seventy-six hemiface allotransplants, between ACI (RT1) donors and Lewis (RT1) recipients, were performed in 11 groups and treated with topical tacrolimus or clobetasol, or in combination with systemic cyclosporine A and anti-αβ-T-cell receptor antibody for 1 week. Topical treatment increased the survival of the allograft in all groups.
Best outcomes were obtained in the groups treated with systemic therapy and topical tacrolimus. Expression of proinflammatory cytokines interleukin 2, interferon γ, tumor necrosis factor α, and transforming growth factor β correlated with clinical signs of rejection and the final outcomes. Clobetasol application was associated with a marked depletion of lymphocytic populations, and dermal and epidermal atrophy.
Both topical tacrolimus and clobetasol were effective in treating episodes of acute rejection, and the best outcomes were achieved when their application was initiated after systemic immunosuppression. Topical tacrolimus proved to be a preferable adjunct agent to the systemic therapy by preventing both the local and systemic complications.
局部免疫抑制剂已被报道可用于治疗血管化复合组织同种异体移植中的排斥反应。本研究旨在评估局部他克莫司和氯倍他索在预防和治疗排斥反应中的有效性。
76 例 ACI（RT1）供体和 Lewis（RT1）受体之间的半面同种异体移植在 11 个组中进行，并在 1 周内接受局部他克莫司或氯倍他索治疗，或联合全身环孢素 A 和抗-αβ-T 细胞受体抗体治疗。局部治疗增加了所有组的同种异体移植物的存活率。
在接受全身治疗和局部他克莫司治疗的组中获得了最佳结果。促炎细胞因子白细胞介素 2、干扰素 γ、肿瘤坏死因子 α 和转化生长因子 β 的表达与排斥反应的临床体征和最终结果相关。氯倍他索的应用与淋巴细胞群的显著耗竭以及皮肤和表皮萎缩有关。
局部他克莫司和氯倍他索均能有效治疗急性排斥反应发作，在全身免疫抑制后开始应用时效果最佳。局部他克莫司通过预防局部和全身并发症，被证明是全身治疗的更优辅助剂。
