成人肠道移植中激素抵抗性急性细胞排斥反应和慢性排斥反应发作后的死亡率：诱导/预处理时代单中心报告

Mortality after steroid-resistant acute cellular rejection and chronic rejection episodes in adult intestinal transplants: report from a single center in induction/preconditioning era.

作者信息

Lauro A, Bagni A, Zanfi C, Pellegrini S, Dazzi A, Del Gaudio M, Ravaioli M, Di Simone M, Ramacciato G, Pironi L, Pinna A D

机构信息

Liver and Multiorgan Transplant Unit, St Orsola University Hospital, Bologna, Italy.

出版信息

Transplant Proc. 2013 Jun;45(5):2032-3. doi: 10.1016/j.transproceed.2012.09.124.

DOI:10.1016/j.transproceed.2012.09.124

PMID:23769102

Abstract

Steroid-resistant acute cellular rejection (ACR) and chronic rejection (CR) are still major concerns after intestinal transplantation. We report our experience from a single center on 48 adults recipients using 49 grafts from 2001 to 2011, immunosuppressing them initially with daclizumab initially and later Alemtuzumab. Overall patient survival was 41.9% at 10 years while graft survival was 38.5%. The steroid-resistant ACR population of 14 recipients (28.5%) experienced 50% mortality mainly due to sepsis, while the five (8%) CR recipients, included two survivors. All but 1 graft was placed without a liver. CR was often preceded by ACR episodes. Mortality related to steroid-resistant ACR and CR still affects the intestinal transplant population despite induction/preconditioning, especially in the absence of a protective liver effect of the liver. New immunosuppressive strategies are needed.

摘要

类固醇抵抗性急性细胞排斥反应（ACR）和慢性排斥反应（CR）仍是肠移植后主要关注的问题。我们报告了2001年至2011年期间来自单一中心的48例成年受者使用49个移植物的经验，最初使用达利珠单抗免疫抑制，随后使用阿仑单抗。10年时总体患者生存率为41.9%，而移植物生存率为38.5%。14例受者（28.5%）的类固醇抵抗性ACR人群主要因败血症导致50%的死亡率，而5例（8%）CR受者中有2例存活。除1个移植物外，所有移植物均在无肝脏的情况下植入。CR常先于ACR发作。尽管进行了诱导/预处理，但与类固醇抵抗性ACR和CR相关的死亡率仍影响肠移植人群，尤其是在没有肝脏的保护肝脏作用的情况下。需要新的免疫抑制策略。