Chen Jeanne M, Mangus Richard S, Sharfuddin Asif A, Powelson John A, Yaqub Muhammad S, Adebiyi Oluwafisayo O, Jan Muhammad Y, Lutz Andrew J, Fridell Jonathan A
Department of Pharmacy, IU Health, Indianapolis, Indiana, USA.
Department of Surgery, IU Health/Indiana University School of Medicine, Indianapolis, Indiana, USA.
Clin Transplant. 2024 Dec;38(12):e70050. doi: 10.1111/ctr.70050.
This single-center retrospective study was designed to evaluate the use of basiliximab as an alternative rescue maintenance immunosuppression in situations where standard maintenance immunosuppression is not tolerated after a pancreas transplant. All pancreas transplants performed between January 11, 2006, and January 6, 2022, were reviewed. All recipients received rabbit antithymocyte globulin (rATG) induction with tacrolimus + sirolimus maintenance for simultaneous pancreas and kidney (SPK) and additional low-dose mycophenolic acid for pancreas transplant alone (PTA). Basiliximab 40mg IV q 4 weeks was either added to or in replacement of adjunct immunosuppression in cases of medication intolerance. All recipients who received ≥3 months of basiliximab with ≥1 year follow-up were included. 29/557 (5.2%) recipients (5 SPK and 24 PTA) were identified. Median time to switch was 13 months. When compared 1:2 to matched controls on standard immunosuppression, there was no difference in pancreas rejection, allograft loss, or mortality. Eleven recipients had 13 episodes of pancreas rejection at a median of 28 months post conversion. Eight pancreas allografts failed at a median of 28 months post conversion, and there were five deaths-all occurring in PTA, 4/5 occurring ≥1 year after discontinuation of basiliximab. Renal allograft rejection occurred in one SPK and there was one renal allograft loss. Five PTA developed renal failure. Ten remain on basiliximab (2/5 SPK, 8/24 PTA) at a median of 44 months with good pancreas and kidney function; 4 pts > 4 years. Basiliximab can be considered an alternative rescue maintenance strategy in pancreas transplant recipients who failed other conventional agents.
这项单中心回顾性研究旨在评估在胰腺移植后无法耐受标准维持免疫抑制的情况下，使用巴利昔单抗作为替代挽救性维持免疫抑制的效果。对2006年1月11日至2022年1月6日期间进行的所有胰腺移植进行了回顾。所有接受者均接受兔抗胸腺细胞球蛋白（rATG）诱导，并使用他克莫司+西罗莫司进行维持治疗，用于同期胰腺和肾脏移植（SPK），单独进行胰腺移植（PTA）的患者还额外使用低剂量霉酚酸。在出现药物不耐受的情况下，每4周静脉注射40mg巴利昔单抗，要么添加到辅助免疫抑制方案中，要么替代辅助免疫抑制方案。纳入所有接受巴利昔单抗治疗≥3个月且随访≥1年的接受者。共识别出29/557（5.2%）名接受者（5例SPK和24例PTA）。转换治疗的中位时间为13个月。与接受标准免疫抑制的匹配对照按1:2进行比较时，胰腺排斥反应、移植物丢失或死亡率无差异。11名接受者在转换治疗后中位28个月时发生了13次胰腺排斥反应。8个胰腺移植物在转换治疗后中位28个月时失败，有5例死亡——均发生在PTA患者中，4/5发生在巴利昔单抗停用≥1年后。1例SPK发生了肾移植排斥反应，有1例肾移植丢失。5例PTA患者出现肾衰竭。10名患者继续使用巴利昔单抗（2/5例SPK，8/24例PTA），中位时间为44个月，胰腺和肾功能良好；4例患者使用时间超过4年。对于其他传统药物治疗失败的胰腺移植接受者，巴利昔单抗可被视为一种替代挽救性维持策略。
