他克莫司、霉酚酸酯和低剂量类固醇联合或不联合白细胞介素-2受体抗体诱导治疗：一项回顾性队列分析。

Tacrolimus, Mycophenolate Mofetil, and Low-Dose Steroids With or Without Interleukin-2 Receptor Antibody Induction Therapy: A Retrospective Cohort Analysis.

作者信息

Schwarz C, Böhmig G, Steininger R, Unger L, Kristo I, Kozakowski N, Berlakovich G A, Soliman T, Mühlbacher F

机构信息

Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria.

Department of Internal Medicine III, Division of Nephrology, Medical University of Vienna, Vienna, Austria.

出版信息

Transplant Proc. 2015 Oct;47(8):2446-9. doi: 10.1016/j.transproceed.2015.08.003.

DOI:10.1016/j.transproceed.2015.08.003

PMID:26518948

Abstract

BACKGROUND

Selective interleukin-2 receptor (IL2R) blockade is one option to decrease acute rejection rates in kidney transplant recipients. However, there are little data on the impact of basiliximab in a triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil, and low-dose steroids). Thus, this analysis aims at investigating the impact of basiliximab induction on rejection rates and immediate graft function following kidney transplantation.

METHODS

Basiliximab was introduced in our center according to our center's policy in the beginning of 2011. Patients who received basiliximab (n = 83) were compared with patients without induction therapy (n = 65) transplanted before the introduction of IL2R antibody induction.

RESULTS

The use of basiliximab as induction therapy decreased the incidence of biopsy-proven acute rejection (BPAR) within the 1st year after transplantation (21.5% vs 14.5%; P = .283). Overall rejection episodes (including BPAR and borderline rejection) were significantly reduced in patients with basiliximab compared with patients without (41.5% vs 24.1%; P = .033). However, graft function (incidence of delayed graft function, primary nonfunction, slow graft function, and serum creatinine decline) and overall outcome (patient and graft survivals) were similar in both groups.

CONCLUSIONS

We found a favorable impact of basiliximab induction therapy on early acute rejection rate. The impact on long-term outcome must be addressed in further randomized controlled trials.

摘要

背景

选择性白细胞介素-2受体（IL2R）阻断是降低肾移植受者急性排斥反应发生率的一种选择。然而，关于巴利昔单抗在三联免疫抑制方案（他克莫司、霉酚酸酯和低剂量类固醇）中的影响的数据很少。因此，本分析旨在研究巴利昔单抗诱导对肾移植后排斥反应发生率和即刻移植肾功能的影响。

方法

根据我们中心的政策，巴利昔单抗于2011年初在我们中心开始使用。将接受巴利昔单抗治疗的患者（n = 83）与在引入IL2R抗体诱导治疗之前进行移植的未接受诱导治疗的患者（n = 65）进行比较。

结果

使用巴利昔单抗作为诱导治疗可降低移植后第1年内活检证实的急性排斥反应（BPAR）的发生率（21.5%对14.5%；P = 0.283）。与未使用巴利昔单抗的患者相比，使用巴利昔单抗的患者总体排斥反应事件（包括BPAR和临界排斥反应）显著减少（41.5%对24.1%；P = 0.033）。然而，两组的移植肾功能（移植肾功能延迟、原发性无功能、移植肾功能缓慢和血清肌酐下降的发生率）和总体结局（患者和移植物存活率）相似。