Light J A, Khawand N, Ali A, Brems W, Aquino A
Department of Transplantation Services, Washington Hospital Center, DC 20010.
Transplant Proc. 1989 Feb;21(1 Pt 2):1738-40.
From May 1977 to April 1988, 88 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; 5 mg intravenous bolus) (n = 28) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 60) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5-16 days for OKT3 (mean, eight days) and 7-14 days for MAG (mean, nine days), as dictated by the post-operative recovery of renal function. All patients were followed for at least four months (maximum 16 months, mean 10 months). Of the 28 patients receiving OKT3, six (21%) had rejection episodes which wre reversed and did not reoccur. Two patients developed OKT3 antibody. Only one graft was lost to rejection. Of the 60 patients receiving MAG, 30 (50%) experienced a first rejection episode within the follow-up period; 15 of these had repeat rejections. Three allografts were subsequently lost in the MAG group. Renal function was significantly better in the OKT3 group. While both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. We conclude that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.
1977年5月至1988年4月，88例接受尸体肾移植的患者被选入一项四联免疫抑制方案的诱导期，接受Orthoclone（OKT3；5mg静脉推注）（n = 28）或明尼苏达抗淋巴细胞球蛋白（MAG；20mg/kg/天）（n = 60）治疗。根据肾功能的术后恢复情况，OKT3的治疗持续时间为5 - 16天（平均8天），MAG为7 - 14天（平均9天）。所有患者均随访至少4个月（最长16个月，平均10个月）。在接受OKT3治疗的28例患者中，6例（21%）发生了排斥反应，经治疗逆转且未复发。2例患者产生了OKT3抗体。仅1例移植肾因排斥反应丢失。在接受MAG治疗的60例患者中，30例（50%）在随访期内经历了首次排斥反应；其中15例发生了再次排斥反应。MAG组随后有3例同种异体移植肾丢失。OKT3组的肾功能明显更好。虽然OKT3和MAG均与患者（98%）和移植肾（92%）的良好存活率相关，但OKT3更易于给药，排斥反应更少。我们得出结论，在尸体肾移植后作为围手术期细胞减灭疗法，OKT3优于MAG。
