Benedetti E, Freels S A, Coady N T, Vasquez E M, Pollak R
Department of Surgery, School of Public Health, University of Illinois, Chicago 60612, USA.
Am J Surg. 1996 Jul;172(1):56-60. doi: 10.1016/S0002-9610(96)00059-1.
Black recipients of kidney transplants have been shown to have lower graft survival than other racial groups. There is ongoing controversy about the optimal immunosuppressive protocol for blacks after kidney transplantation.
Five hundred-eighty-two recipients of kidney transplants performed between 1985 and 1994 were divided into three groups: (1) nonblacks who received cyclosporine and prednisone (N = 292); (2) blacks who received "quadruple" cyclosporine based immunosuppression with OKT3 induction (N = 98); and (3) blacks who received cyclosporine and prednisone only (N = 192). Patient and graft survival and incidence of acute rejection episodes were compared among the groups.
Blacks had lower graft survival when compared with nonblacks. However, in the subgroup of black recipients who received quadruple immunosuppression, graft survival at 1 year was higher and the incidence of acute rejection episodes was significantly decreased compared with blacks without induction. Graft survival and the incidence of acute rejection in blacks on quadruple therapy was comparable with nonblacks.
Our data support the principle that quadruple immunosuppression should be used routinely for black recipients of kidney transplants.
肾移植黑人受者的移植物存活率低于其他种族群体。肾移植后黑人的最佳免疫抑制方案一直存在争议。
1985年至1994年间进行肾移植的582例受者被分为三组：（1）接受环孢素和泼尼松的非黑人（N = 292）；（2）接受基于环孢素的“四联”免疫抑制并使用OKT3诱导的黑人（N = 98）；（3）仅接受环孢素和泼尼松的黑人（N = 192）。比较各组患者和移植物的存活率以及急性排斥反应的发生率。
与非黑人相比，黑人的移植物存活率较低。然而，在接受四联免疫抑制的黑人受者亚组中，与未进行诱导的黑人相比，1年时的移植物存活率更高，急性排斥反应的发生率显著降低。接受四联疗法的黑人的移植物存活率和急性排斥反应发生率与非黑人相当。
我们的数据支持肾移植黑人受者应常规使用四联免疫抑制的原则。
