肾移植后的体液免疫：两种随机免疫抑制方案的影响
Humoral immunity after kidney transplantation: impact of two randomized immunosuppressive protocols.
作者信息
Legris Tristan, Picard Christophe, Moal Valérie, Burtey Stéphane, Loundou Anderson, Purgus Raj, Dussol Bertrand, Berland Yvon, Vacher-Coponat Henri
机构信息
Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France and Aix Marseille Univ, Marseille, France.
出版信息
Ann Transplant. 2013 Nov 15;18:622-34. doi: 10.12659/AOT.889536.
BACKGROUND
Controlling alloimmune humoral response is a challenge in transplantation. Few studies have evaluated the impact of maintenance immunosuppression on blood humoral parameters.
MATERIAL/METHODS: We performed a post-hoc analysis on 307 kidney transplant recipients included in a prospective randomized trial comparing tacrolimus/mycophenolate mofetil (Tac/MMF) vs. cyclosporine/azathioprine (CsA/AZA), both used with antithymocyte globulin induction and steroids. Humoral parameters were analyzed at D0, D15, and M12.
RESULTS
IgG, IgA, and IgM levels decreased significantly as soon as D15 in both groups (–35%, –26%, and –35% respectively, vs. D0). At M12, although peripheral B-cell counts did not differ between the groups, Tac/MMF regimen was associated with lower IgG, IgA, and IgM levels than CsA/AZA (–5.9%, –14.6%, and –34%, respectively). Hypogammaglobulinemia at D15 was not associated with an increased risk of infections during the first year. The proportion of HLA-sensitized patients decreased in the Tac/MMF group (15.9% at D0 and 6.7% at M12, p=0.02) and remained stable in the CsA/AZA group (10.3% at D0 and 8.9% at M12, p=0.5). More patients sensitized at baseline became non-sensitized at M12 with Tac/MMF than with CsA/AZA.
CONCLUSIONS
Our results suggest humoral immunosuppression is better with Tac/MMF than with CsA/AZA during the first year of kidney transplantation.
背景
控制同种异体免疫体液反应是移植领域的一项挑战。很少有研究评估维持性免疫抑制对血液体液参数的影响。
材料/方法：我们对307名肾移植受者进行了一项事后分析，这些受者纳入了一项前瞻性随机试验，该试验比较了他克莫司/霉酚酸酯（Tac/MMF）与环孢素/硫唑嘌呤（CsA/AZA），两者均与抗胸腺细胞球蛋白诱导剂和类固醇联合使用。在第0天、第15天和第12个月分析体液参数。
结果
两组在第15天时IgG、IgA和IgM水平均显著下降（分别比第0天下降35%、26%和35%）。在第12个月时，尽管两组外周血B细胞计数无差异，但Tac/MMF方案与低于CsA/AZA的IgG、IgA和IgM水平相关（分别低5.9%、14.6%和34%）。第15天时的低丙种球蛋白血症与第一年感染风险增加无关。Tac/MMF组中HLA致敏患者的比例下降（第0天为15.9%，第12个月为6.7%，p = 0.02），而CsA/AZA组保持稳定（第0天为10.3%，第12个月为8.9%，p = 0.5）。与CsA/AZA相比，更多基线致敏的患者在第12个月时使用Tac/MMF变为非致敏状态。
结论
我们的结果表明，在肾移植的第一年，Tac/MMF的体液免疫抑制效果优于CsA/AZA。
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