Department of Medicine, Mayo Clinic, Phoenix, AZ, USA.
Clin Transplant. 2013 Sep-Oct;27(5):772-80. doi: 10.1111/ctr.12201. Epub 2013 Aug 8.
In a recent clinical trial in kidney transplant recipients, induction with alemtuzumab and rabbit-antithymocyte globulin (r-ATG) was equally effective in preventing rejection during the first post-transplant year; however, this study did not include protocol biopsies.
The aim of this study was to analyze the impact of alemtuzumab induction on rejection and subclinical inflammation during the first post-transplant year compared with a historic control group receiving induction with r-ATG. All patients received tacrolimus and mycophenolate mofetil (MMF).
There were 361 in the alemtuzumab group and 478 in the r-ATG groups. Rejection (excluding Banff borderline), during the first year, occurred in 14% of the alemtuzumab group and 9% of the r-ATG group (p = 0.03). Estimated glomerular filtration rate (GFR) (chronic kidney disease (CKD)-EPI formula) at one yr and graft survival at three yr were similar. On the protocol biopsies, interstitial inflammation (Banff i scores) and tubulitis (Banff t scores) were more likely in the r-ATG group at one month, but at four and 12 months, both inflammation and tubulitis were more likely in the alemtuzumab group.
We conclude that alemtuzumab induction is associated with delayed inflammation at four and 12 months, but this inflammation did not appear to negatively impact the GFR or graft survival.
在最近一项肾移植受者的临床试验中，阿仑单抗联合兔抗胸腺细胞球蛋白（r-ATG）诱导治疗在移植后第一年预防排斥反应的效果与 r-ATG 相当；然而，该研究并未包括方案活检。
本研究旨在分析与接受 r-ATG 诱导的历史对照组相比，阿仑单抗诱导治疗在移植后第一年对排斥反应和亚临床炎症的影响。所有患者均接受他克莫司和霉酚酸酯（MMF）治疗。
阿仑单抗组 361 例，r-ATG 组 478 例。阿仑单抗组第一年排斥反应（不包括 Banff 边缘型）发生率为 14%，r-ATG 组为 9%（p = 0.03）。一年时估计肾小球滤过率（CKD-EPI 公式）和三年时移植物存活率相似。方案活检显示，一个月时 r-ATG 组间质炎症（Banff i 评分）和肾小管炎（Banff t 评分）更常见，但四个月和十二个月时阿仑单抗组炎症和肾小管炎更常见。
我们的结论是，阿仑单抗诱导治疗与四个月和十二个月时的迟发性炎症相关，但这种炎症似乎并未对肾小球滤过率或移植物存活率产生负面影响。
