Opelz G
Department of Transplantation Immunology, University of Heidelberg, Germany.
Kidney Int Suppl. 1995 Dec;52:S89-92.
The efficacy of different immunosuppressive regimens was analyzed in a multicenter series of cadaver kidney transplants reported to the Collaborative Transplant Study. Induction therapy with steroid-free cyclosporine regimens resulted in significantly better graft survival than induction including a combination of cyclosporine and steroids (P < 0.001) or azathioprine and steroids (P < 0.0001). Because immunosuppressive protocols frequently changed during the first post-transplant year, graft survival from the first to the fifth year was used to analyze the efficacy of long-term maintenance immunosuppressive regimens. Steroid-free maintenance with cyclosporine resulted in significantly better five-year graft survival (P < 0.0001) and patient survival (P < 0.01) than maintenance with steroid-containing cyclosporine regimens or maintenance on azathioprine and steroids without cyclosporine (P < 0.0001). Steroid-free patients received significantly higher doses of cyclosporine than patients on steroid-containing cyclosporine regimens. These results suggest that steroid-free maintenance immunosuppression with cyclosporine should be attempted in patients with an uncomplicated posttransplant course.
在向移植协作研究报告的多中心系列尸体肾移植中，分析了不同免疫抑制方案的疗效。与包含环孢素和类固醇的诱导方案（P < 0.001）或硫唑嘌呤和类固醇的诱导方案（P < 0.0001）相比，无类固醇环孢素方案的诱导治疗导致移植物存活率显著更高。由于移植后第一年免疫抑制方案经常变化，因此使用移植后第一年到第五年的移植物存活率来分析长期维持免疫抑制方案的疗效。与含类固醇环孢素方案维持或无环孢素的硫唑嘌呤和类固醇维持相比，无类固醇环孢素维持导致五年移植物存活率显著更高（P < 0.0001）和患者存活率显著更高（P < 0.01）（P < 0.0001）。无类固醇患者接受的环孢素剂量显著高于含类固醇环孢素方案的患者。这些结果表明，对于移植后过程无并发症的患者，应尝试无类固醇环孢素维持免疫抑制。
