Delmonico F L, Auchincloss H, Rubin R H, Russell P S, Tolkoff-Rubin N, Fang L T, Cosimi A B
General Surgical Services, Massachusetts General Hospital, Boston 02114.
Ann Surg. 1987 Nov;206(5):649-54. doi: 10.1097/00000658-198711000-00016.
Eighty-seven adult renal allograft recipients were initially treated with cyclosporine-prednisone immunosuppression. Thirty patients experienced no episode of rejection. Antilymphocyte antibody therapy (ALS) was administered to 21 of the 68 recipients of cadaveric donor allografts for either primary allograft dysfunction or acute rejection, and to 6 of 19 recipients of haploidentical, living-related allografts because of steroid-resistant rejection. The cumulative allograft and patient survival for the entire series (follow-up 9-36 months) was 84% and 95%, respectively. This improvement in the rate of successful transplantation can be attributed to the selective addition of ALS therapy to recipients with specific instances of renal allograft dysfunction. In this report, the indications for the use of ALS preparations following prophylactic CsA immunosuppression are reviewed. Experience with the protocols of the ALS administration is also discussed. In selected cases, the administration of either ATG or OKT3 can significantly benefit CsA recipients who experience either primary allograft nonfunction or an epidose of acute rejection.
87例成人肾移植受者最初接受环孢素 - 泼尼松免疫抑制治疗。30例患者未发生排斥反应。68例尸体供肾移植受者中有21例因原发性移植肾功能障碍或急性排斥反应接受了抗淋巴细胞抗体治疗（ALS），19例单倍体相合的亲属活体肾移植受者中有6例因激素抵抗性排斥反应接受了该治疗。整个系列（随访9 - 36个月）的移植肾累积存活率和患者存活率分别为84%和95%。成功移植率的提高可归因于对有特定肾移植功能障碍情况的受者选择性地加用ALS治疗。在本报告中，回顾了预防性应用环孢素免疫抑制后使用ALS制剂的指征。还讨论了ALS给药方案的经验。在某些选定病例中，给予抗胸腺细胞球蛋白（ATG）或OKT3可使发生原发性移植肾无功能或急性排斥反应的环孢素治疗受者显著受益。
