Ryckman F C, Schroeder T J, Pedersen S H, Dittrich V S, Balistreri W F
Children's Hospital Medical Center, University of Cincinnati, Ohio 45229-3039, USA.
Transplant Sci. 1994 Dec;4 Suppl 1:S20-5.
The goal of any posttransplant immunosuppressive regimen is to prevent allograft rejection while minimizing infectious complications. We hypothesized that sequential induction immunotherapy using the monoclonal antibody ORTHOCLONE OKT3 (muromonab-CD3) would meet these objectives effectively. We have therefore used such a protocol since July 1988 for all pediatric patients undergoing liver transplantation at Children's Hospital Medical Center of Cincinnati. Initial immunotherapy consisted of OKT3, administered preoperatively and then QD, methylprednisolone, and azathioprine. Cyclosporine was begun on POD 3-5, and OKT3 was discontinued when therapeutic cyclosporine levels were achieved for 48 hours. Rejection has not occurred throughout the lifetime of the allograft in 55% of long-term survivors. In the 28 patients who experienced rejection episodes, 71% had a single episode, 21% had two episodes, and 7% had a single episode, 21% had two episodes, and 7% had more than two. Rejection occurring after more than 120 days was invariably associated with noncompliance or subtherapeutic cyclosporine levels. The use of an OKT3-based sequential induction protocol resulted in a decreased incidence of acute rejection. Renal function was preserved, and the incidence of infection was not increased. Long-term outcome analysis of this protocol shows excellent patient survival and the near absence of late or chronic rejection.
任何移植后免疫抑制方案的目标都是预防同种异体移植排斥反应，同时将感染并发症降至最低。我们假设使用单克隆抗体ORTHOCLONE OKT3（莫罗单抗-CD3）进行序贯诱导免疫疗法能够有效实现这些目标。因此，自1988年7月以来，我们在辛辛那提儿童医院医疗中心对所有接受肝移植的儿科患者都采用了这样的方案。初始免疫疗法包括术前给予OKT3，然后每日一次，同时给予甲泼尼龙和硫唑嘌呤。术后第3至5天开始使用环孢素，当环孢素达到治疗水平48小时后停用OKT3。55%的长期存活者在同种异体移植的整个生存期内未发生排斥反应。在经历排斥反应的28例患者中，71%发生单次排斥反应，21%发生两次，7%发生两次以上。120天后发生的排斥反应总是与不依从或环孢素水平未达到治疗剂量有关。使用基于OKT3的序贯诱导方案可降低急性排斥反应的发生率。肾功能得以保留，感染发生率未增加。对该方案的长期结果分析显示患者存活率极高，几乎不存在晚期或慢性排斥反应。
