Combined simultaneous kidney/bone marrow transplantation.
Combined simultaneous kidney/bone marrow transplantation.
复制标题
联合同步肾/骨髓移植。
DOI：
10.1097/00007890-199560120-00009
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发表时间：
1995
期刊：
影响因子：
6.2
通讯作者：
Egidi,F
中科院分区：
文献类型：
--
作者：
Shapiro,R;Rao,AS;Fontes,P;Zeevi,A;Jordan,M;Scantlebury,VP;Vivas,C;Gritsch,HA;Corry,RJ;Egidi,F
基于对长期（28-30年）肾移植存活患者的观察，所有患者都有全身微嵌合的证据，我们开始了肾/骨髓联合同时移植计划。1992年12月14日至1994年10月31日，36例肾移植受者接受3-5x108个未修饰骨髓细胞/kg；6例患者同时接受胰岛移植，7例患者同时接受胰腺移植。受者平均年龄为39.0±10.8岁，供者平均年龄为31.8±16.1岁；平均冷缺血时间23.0+/-9.1 hr。20例对照患者单独接受肾脏移植，主要是因为供体家庭拒绝同意椎体恢复；其中3名患者还接受了胰腺移植。受者平均年龄为47.9±11.7岁，供者平均年龄为41.5±17.9岁；平均冷缺血时间28.6±6.2小时。所有患者均接受以他克莫司为基础的治疗，无放疗、细胞减少或诱导抗淋巴细胞制剂。在移植前和移植后定期抽血检测嵌合和免疫学研究。平均随访11.1+/-5.8个月，所有36例患者均存活，33例（92%）具有同种异体移植物功能，平均血清肌酐为1.9+/-1.2 mg/dl， BUN为26+/-9 mg/dl。所有患者均未见移植物抗宿主病。排斥反应发生率为72%；11%的患者需要OKT3或ATG治疗类固醇抵抗性排斥。CMV的发生率为14%，移植物功能延迟的发生率为17%。对照组共有18例（90%）存活，17例（85%）移植同种异体移植物功能正常，平均血清肌酐为2.1+/-1.3 mg/dl， BUN为30+/-13 mg/dl。排斥反应发生率为60%，10%需要OKT3或ATG。CMV占15%，移植物功能延迟占20%（P= NS）。在研究患者中，通过PCR或流式细胞术在31例可评估患者中的30例（97%）的外周血中检测到嵌合。在对照组中，14例可评估患者中有9例（64%）出现嵌合（P< 0.05）。02)。在6/29（21%）可评估研究和4/14（29%）可评估对照患者中发现供体特异性反应性降低（P= NS）。我们得出结论，肾/骨髓联合移植与可接受的患者和移植物存活、嵌合增强以及移植后早期事件无变化相关。
On the basis of observations in patients with longterm (28-30 years) renal allograft survival, all of whom had evidence of systemic microchimerism, we began a program of combined simultaneous kidney/bone marrow transplantation. Between 12/14/92, and 10/31/94, 36 kidney transplant recipients received 3-5x108 unmodified bone marrow cells/kg; 6 patients also received pancreatic islets, and 7 patients also received a pancreas. The mean recipient age was 39.0+/-10.8 years, and the mean donor age was 31.8+/-16.1 years; the mean cold ischemia time was 23.0+/-9.1 hr. Twenty control patients received kidneys alone, mainly because of refusal by the donor family to consent to vertebral body recovery; 3 of these patients also received a pancreas. The mean recipient age was 47.9+/-11.7 years, and the mean donor age was 41.5+/-17.9 years; the mean cold ischemia time was 28.6+/-6.2 hr. All patients received tacrolimus-based therapy, without radiation, cytoreduction, or induction antilymphocyte preparations. Blood was drawn prior to and at regular intervals after transplantation for detection of chimerism and for immunologic studies. With a mean follow-up of 11.1+/-5.8 months, all 36 study patients are alive, and 33 (92%) have functioning allografts with a mean serum creatinine of 1.9+/-1.2 mg/dl and a BUN of 26+/-9 mg/dl. Graft vs. host disease was not seen in any patient. The incidence of rejection was 72%; 11% of the patients required OKT3 or ATG for steroid-resistant rejection. The incidence of CMV was 14%, and that of delayed graft function was 17%. A total of 18 (90%) control patients are alive, and 17 (85%) have functioning allografts, with a mean serum creatinine of 2.1+/-1.3 mg/dl, and a BUN of 30+/-13 mg/dl. The incidence of rejection was 60%, and 10% required OKT3 or ATG. CMV was seen in 15%, and delayed graft function in 20%(P= NS). In the study patients, chimerism was detected in the peripheral blood of 30 of 31 (97%) evaluable patients by either PCR or flow cytometry. In the control patients, chimerism was seen in 9 of 14 (64%) evaluable patients (P<. 02). Decreasing donor-specific responsiveness was seen in 6/29 (21%) evaluable study, and 4/14 (29%) evaluable control patients (P= NS). We conclude that combined kidney/bone marrow transplantation is associated with acceptable patient and graft survival, augmentation of chimerism, and no change in the early events after transplantation.