Hricik D E
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Transplant Proc. 1998 Sep;30(6):2721-3. doi: 10.1016/s0041-1345(98)00796-9.
Complete or partial withdrawal of immunosuppression is a desirable goal for physicians managing solid organ transplant recipients and has particular appeal for the management of composite tissue allograft recipients. Experience to date with steroid withdrawal or cyclosporine withdrawal in organ transplant recipients suggests that the risks of acute rejection are minimized with slow tapering of the drugs and when drug withdrawal is attempted many months or years after transplantation. Unfortunately, the full benefits of withdrawing any component of a multidrug immunosuppression regimen can probably be achieved only when the drug is withdrawn relatively early after transplantation. Thus, there is a need for improved immunologic monitoring to facilitate withdrawal of immunosuppression in any setting. Because steroid withdrawal might be particularly advantageous to the recipient of a composite tissue allograft, further experience is needed to determine the safety of steroid withdrawal with newer immunosuppressants such as tacrolimus, mycophenolate mofetil, and sirolimus.
对于管理实体器官移植受者的医生而言，完全或部分停用免疫抑制是一个理想目标，对于复合组织同种异体移植受者的管理尤其具有吸引力。迄今为止，器官移植受者停用类固醇或环孢素的经验表明，通过缓慢减少药物剂量以及在移植后数月或数年尝试停药时，急性排斥反应的风险可降至最低。不幸的是，只有在移植后相对早期停药时，才可能实现停用多药免疫抑制方案中任何一种药物的全部益处。因此，需要改进免疫监测，以促进在任何情况下停用免疫抑制。由于停用类固醇对复合组织同种异体移植受者可能特别有利，因此需要更多经验来确定使用他克莫司、霉酚酸酯和西罗莫司等新型免疫抑制剂停用类固醇的安全性。
