Petrie J J, Rigby R J, Hawley C M, Suranyi M G, Whitby M, Wall D, Hardie I R
Renal Transplant Unit, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia.
Transplantation. 1995 Feb 15;59(3):347-52.
Between January 1, 1982, and November 1, 1986, 169 cadaver renal graft transplantations were performed at this hospital with CsA as induction therapy. OKT3 was not available in this period. Of these grafts, 15.9% were lost within 6 months, 10.7% from acute rejection (AR). Between November 1, 1986, and October 1, 1992, 483 cadaver renal graft transplantation were performed. Induction therapy included CsA and OKT3 was available. Of these grafts, 8.7% were lost inside 6 months, 3.1% from AR. Of these last 483 grafts, 113 received 125 courses of OKT3. Ten courses were prophylactic, and 115 courses in 103 patients were for rejection resistant to steroid therapy (biopsy proven in all but 2 cases. Ninety-three percent of rejection episodes treated with OKT3 responded, at least initially. Graft survival in OKT3-treated patients was 81%, 77%, and 76% at 6 months, 1 year, and 2 years, respectively. In contrast, graft survival in steroid-resistant rejection during the first period (without OKT3) was 59%, 57%, and 57% at these intervals. There were 8 infective deaths within 6 months in the 113 OKT3-treated patients, compared with 2 in the 343 who did not receive OKT3 (P < 0.001). There were 7 viral deaths in the OKT3 group compared with none in those not receiving OKT3 (P < 0.001). Prophylaxis with oral acyclovir and cotrimoxazole was instituted in October 1990 in OKT3-treated patients and ganciclovir use was increased. Since this change, no further viral deaths have occurred. OKT3 is a very effective antirejection agent, but its use is associated with an increased mortality from viral infections. With appropriate prophylaxis and treatment, however, this mortality can be reduced.
1982年1月1日至1986年11月1日期间，本院进行了169例尸体肾移植，采用环孢素A（CsA）作为诱导治疗。在此期间没有可用的OKT3。在这些移植肾中，15.9%在6个月内丢失，其中10.7%因急性排斥反应（AR）而丢失。1986年11月1日至1992年10月1日期间，进行了483例尸体肾移植。诱导治疗包括CsA且有OKT3可用。在这些移植肾中，8.7%在6个月内丢失，其中3.1%因AR而丢失。在这最后的483例移植肾中，113例接受了125个疗程的OKT3治疗。10个疗程为预防性治疗，103例患者中的115个疗程用于治疗对类固醇治疗耐药的排斥反应（除2例外在所有病例中均经活检证实）。接受OKT3治疗的排斥反应发作中，至少在初始阶段93%有反应。接受OKT3治疗的患者在6个月、1年和2年时的移植肾存活率分别为81%、77%和76%。相比之下，在第一阶段（无OKT3）对类固醇耐药的排斥反应中，这些时间点的移植肾存活率分别为59%、57%和57%。在接受OKT3治疗的113例患者中，有8例在6个月内死于感染，而在未接受OKT3治疗的343例患者中有2例（P<0.001）。OKT3组有7例死于病毒感染，而未接受OKT3治疗的患者中无死亡病例（P<0.001）。1990年10月对接受OKT3治疗的患者开始使用口服阿昔洛韦和复方新诺明进行预防，并增加了更昔洛韦的使用。自这一改变以来，未再发生病毒感染导致的死亡。OKT3是一种非常有效的抗排斥药物，但其使用与病毒感染导致的死亡率增加有关。然而，通过适当的预防和治疗，这种死亡率可以降低。
