Outcomes at 3 years of a prospective pilot study of Campath-1H and sirolimus immunosuppression for renal transplantation
Outcomes at 3 years of a prospective pilot study of Campath-1H and sirolimus immunosuppression for renal transplantation
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DOI：
10.1111/j.1432-2277.2006.00388.x
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发表时间：
2006-11-01
影响因子：
3.1
通讯作者：
Knechtle, Stuart J.
中科院分区：
文献类型：
--
作者：
Barth, Rolf N.;Janus, Christina A.;Knechtle, Stuart J.
Campath-1H（阿仑单抗）诱导与西罗莫司联合用于肾移植，作为免疫抑制剂。我们以前报道过这种方案的早期排斥发生率很高（28%），现在报告3年的结果。29例患者接受了死亡供体或非HLA（人类白细胞抗原）相同的活体供体初次同种异体肾移植。临床参数包括感染、恶性肿瘤、肾功能和肾组织学前瞻性随访3年。三年累积移植物和患者存活率分别为96%和100%。20例患者维持无类固醇免疫抑制方案，15例患者维持免疫抑制单药治疗（12例西罗莫司）。没有观察到严重的感染并发症，两名患者患上了基底细胞皮肤癌。我们初步研究的3年结果表明移植物（96%）和患者（100%）结局良好。Campath-1H诱导产生了高比例的患者维持免疫抑制单药治疗（57%），没有严重的感染和恶性肿瘤相关的并发症。报告的方案产生了新的见解Campath-1H和西罗莫司治疗肾移植。由于早期排斥反应的发生率较高，我们建议采用改良的免疫抑制策略，包括短期使用钙调磷酸酶抑制剂。
Campath-1H (alemtuzumab) induction was used for renal transplantation in combination with sirolimus as immunosuppression. We previously reported a high (28%) rate of early rejection with this regimen, and now report 3-year outcomes. Twenty-nine patients were recipients of either deceased donor or non-HLA (Human Leukocyte Antigen) identical living donor primary renal allografts. Clinical parameters including infection, malignancy, kidney function, and kidney histology were followed prospectively for 3 years. Three-year cumulative graft and patient survival were 96% and 100%, respectively. Twenty patients were maintained on steroid-free immunosuppressive regimens, and 15 patients were maintained on monotherapy for immunosuppression (12 on sirolimus). No serious infectious complications were observed and two patients developed basal cell skin cancer. The 3-year results of our initial pilot study demonstrate good graft (96%) and patient (100%) outcomes. Campath-1H induction has yielded a high proportion of patients maintained on immunosuppressive monotherapy (57%) without serious infectious- and no malignancy-related complications. The reported regimen yielded novel insights into both Campath-1H and sirolimus therapy in renal transplantation. Because of the higher incidence of early rejection, we recommend a modified strategy of immunosuppression including a brief course of a calcineurin inhibitor.