Heldal Kristian, Thorarinsdottir Solveig, Hartmann Anders, Leivestad Torbjørn, Reisæter Anna V, Foss Aksel Espen, Midtvedt Karsten
Clinic of Internal Medicine, Telemark Hospital, 3710, Skien, Norway.
Transplant Res. 2013 Jun 26;2(1):11. doi: 10.1186/2047-1440-2-11.
The most important limiting factor in kidney transplantation is the scarcity of donor organs. Consequently, there is an increased use worldwide of kidneys from older deceased donors. High donor age is a known risk factor for acute cellular rejection and premature graft failure, and the optimal immunosuppressive regimen in these circumstances remains to be established.
We investigated whether induction treatment with an interleukin 2 (IL-2) receptor antagonist improves graft survival and reduces rejection episodes in recipients of kidneys from deceased donors aged ≥ 60 years. Data were retrieved for all recipients transplanted at our center from 2004 to 2009 with a kidney from a deceased donor aged > 60 years. The outcome was compared between recipients treated with (IL-2 plus) or without (IL-2 minus) an IL-2 receptor antagonist. All recipients received a calcineurin inhibitor, steroids and mycophenolate.
A total of 232 first-transplant recipients were included (IL-2 plus = 149, IL-2 minus = 83). IL-2 minus was associated with increased risk of early acute rejection (OR 2.42; 95% CI 1.25 to 4.68, P = 0.009) and steroid-resistant rejection (OR 8.04; 2.77 to 23.25, P< 0.001). IL-2 plus patients had superior two-year estimated uncensored (87% versus 70%, P = 0.001) and death-censored (95% versus 79%, P< 0.001) graft survival.
Induction treatment with IL-2 receptor antagonist was associated with a reduction in acute rejection episodes and improved two-year graft survival in patients transplanted with kidneys from older deceased donors.
肾移植中最重要的限制因素是供体器官的稀缺。因此，全球范围内使用老年已故供体肾脏的情况有所增加。供体年龄高是急性细胞排斥和移植肾过早失功的已知危险因素，而在这些情况下的最佳免疫抑制方案仍有待确定。
我们调查了用白细胞介素2（IL-2）受体拮抗剂进行诱导治疗是否能提高≥60岁已故供体肾脏受者的移植肾存活率并减少排斥反应。检索了2004年至2009年在我们中心接受≥60岁已故供体肾脏移植的所有受者的数据。比较了接受（IL-2加）或未接受（IL-2减）IL-2受体拮抗剂治疗的受者的结局。所有受者均接受钙调神经磷酸酶抑制剂、类固醇和霉酚酸酯。
共纳入232例首次移植受者（IL-2加=149例，IL-2减=83例）。IL-2减与早期急性排斥反应风险增加（比值比2.42；95%置信区间1.25至4.68，P=0.009）和类固醇抵抗性排斥反应（比值比8.04；2.77至23.25，P<0.001）相关。IL-2加组患者的两年估计未删失移植肾存活率更高（87%对70%，P=0.001），死亡删失移植肾存活率也更高（95%对79%，P<0.001）。
在接受老年已故供体肾脏移植的患者中，用IL-2受体拮抗剂进行诱导治疗与急性排斥反应减少和两年移植肾存活率提高相关。
