Kittipibul Veraprapas, Tantrachoti Pakpoom, Ongcharit Pat, Ariyachaipanich Aekarach, Siwamogsatham Sarawut, Sritangsirikul Supaporn, Thammanatsakul Kanokwan, Puwanant Sarinya
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Clin Transplant. 2017 Dec;31(12). doi: 10.1111/ctr.13132. Epub 2017 Nov 3.
We prospectively studied efficacy and safety outcomes of two 10-mg doses of intravenous basiliximab on day 0 and day 4 for induction therapy in 17 consecutive de novo heart transplant recipients. By the 2-week assessment post-transplant, there were no deaths, graft failures, or acute cellular rejections (ACRs) ISHLT grade ≥ 2R. By the 1-year assessment post-transplant, there were 1 (6%) infectious death, no graft failures, 2 (12%) grade 2R ACRs, 6 (35%) asymptomatic cytomegalovirus (CMV) infections, and 4 (25%) treated infections. Our study was the first to show that low-dose basiliximab induction in heart transplant resulted in favorable efficacy and safety outcomes. Additionally, calcineurin inhibitor (CNI) initiation in a low-risk population could be safely delayed using the strategy of modified low-dose postoperative basiliximab. This strategy also appears to allow subsequent early corticosteroid wean, although with the concomitant maintenance of higher CNI levels and higher dosing of mycophenolate.
我们前瞻性地研究了在17例连续的初发心脏移植受者中，于第0天和第4天静脉注射两剂10毫克巴利昔单抗进行诱导治疗的疗效和安全性结果。移植后2周评估时，无死亡、移植物失败或国际心脏和肺移植学会（ISHLT）2R级及以上的急性细胞排斥反应（ACR）。移植后1年评估时，有1例（6%）感染性死亡，无移植物失败，2例（12%）2R级ACR，6例（35%）无症状巨细胞病毒（CMV）感染，4例（25%）接受治疗的感染。我们的研究首次表明，心脏移植中低剂量巴利昔单抗诱导治疗可产生良好的疗效和安全性结果。此外，采用改良低剂量术后巴利昔单抗策略，低风险人群中钙调神经磷酸酶抑制剂（CNI）的起始使用可安全延迟。该策略似乎还允许随后早期停用皮质类固醇，尽管同时要维持较高的CNI水平和较高剂量的霉酚酸酯。
