Kaabak Michael M, Babenko Nadeen N, Shapiro Ron, Maschan Alexey A, Zokoev Allan K, Schekaturov Stanislav V, Vyunkova Julia N, Dymova Olga V
Organ Transplant Division, Boris Petrovsky Research Center of Surgery, Moscow, Russia.
Kidney Transplant Department, Boris Petrovsky Research Center of Surgery, Moscow, Russia.
Pediatr Transplant. 2017 Aug;21(5). doi: 10.1111/petr.12941. Epub 2017 Jun 10.
Recipient lymphocytes are crucial for direct and indirect pathways of allorecognition. We proposed that the administration of alemtuzumab several weeks pretransplantation could eradicate peripheral lymphatic cells and promote donor-specific acceptance. This was a single-center, retrospective review of 101 consecutive living donor kidney transplantations in pediatric patients (age 7 months-18 years), performed between September 2006 and April 2010. IS protocol included two 30 mg doses of alemtuzumab: The first was given 12-29 days prior to transplantation, and the second at the time of transplantation. Maintenance IS was based on combination of low-dose CNI and mycophenolate, with steroids tapered over the first 5 days post-transplantation. Patients were followed for 7.8±1.3 years, and protocol biopsies were taken 1 month, 1, 3, and 5 years post-transplant. The Kaplan-Meier 8-year patient and graft survival rates in the cyclosporine-treated patients were 82.0±7.3% and 71.6±7.3, and in the tacrolimus-treated patients were 97.2±5.4 and 83.8±6.0%. Biopsy-proven acute rejection developed in 35% of cyclosporine-treated patients and in 8% of tacrolimus-treated patients. Alemtuzumab pretreatment prior to LRD kidney transplantation, followed by maintenance immunosuppression with tacrolimus and MMF, is associated with reasonable long-term results in pediatric patients.
受体淋巴细胞对于同种异体识别的直接和间接途径至关重要。我们提出，在移植前数周给予阿仑单抗可以根除外周淋巴细胞并促进供体特异性接受。这是一项对2006年9月至2010年4月间连续进行的101例小儿患者（年龄7个月至18岁）活体供肾移植的单中心回顾性研究。免疫抑制方案包括两剂30mg的阿仑单抗：第一剂在移植前12 - 29天给予，第二剂在移植时给予。维持免疫抑制基于低剂量钙调神经磷酸酶抑制剂（CNI）和霉酚酸酯的联合使用，移植后前5天逐渐减少类固醇用量。对患者进行了7.8±1.3年的随访，并在移植后1个月、1年、3年和5年进行方案活检。环孢素治疗组患者的Kaplan - Meier 8年患者和移植物存活率分别为82.0±7.3%和71.6±7.3%，他克莫司治疗组患者分别为97.2±5.4%和83.8±6.0%。活检证实的急性排斥反应在35%的环孢素治疗患者和8%的他克莫司治疗患者中发生。在小儿患者中，LRD肾移植前进行阿仑单抗预处理，随后用他克莫司和霉酚酸酯维持免疫抑制，可获得合理的长期效果。
