Exogenous Interferon-γ Immunotherapy for Invasive Fungal Infections in Kidney Transplant Patients
Exogenous Interferon-γ Immunotherapy for Invasive Fungal Infections in Kidney Transplant Patients
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DOI：
10.1111/j.1600-6143.2010.03094.x
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发表时间：
2010-08-01
影响因子：
8.8
通讯作者：
Shaunak, S.
中科院分区：
文献类型：
--
作者：
Armstrong-James, D.;Teo, I. A.;Shaunak, S.
非中性粒细胞减少性实体器官移植患者中侵袭性真菌感染（IFIs）的发生率正在增加。我们报告了对 7 名肾移植患者使用干扰素-γ (IFN-γ) 免疫治疗的临床经验，这些患者出现了危及生命的、传统抗真菌药物治疗难治的播散性 IFI。这些感染均经过微生物学和组织学证实。尽管在所有病例中都使用了脂质体两性霉素 B，但通过外源性 IFN-γ 注射快速治愈这些播散性感染与同种异体移植肾功能受损无关。没有发现 IFN-γ 免疫疗法的临床毒性，并且在长期随访期间没有 IFI 复发。我们的经验是不受控制的，并且患者的真菌感染相关结果不可预测。然而，与标准方法相比，通过 6 周联合抗真菌药物治疗和 IFN-γ 免疫治疗加速治愈危及生命的播散性 IFI，挽救了生命，保留了同种异体移植功能，并为这一小患者群体节省了大量成本。
The incidence of invasive fungal infections (IFIs) in nonneutropenic solid organ transplant patients is increasing. We report our clinical experience with the use of interferon-gamma (IFN-gamma) immunotherapy in seven renal transplant patients who developed life threatening, disseminated IFIs refractory to conventional antifungal drug therapy. The infections were all microbiologically and histologically proven. The rapid cure of these disseminated infections with exogenous IFN-gamma injections was not associated with impaired kidney allograft function despite the use of liposomal amphotericin B in all cases. No clinical toxicity from the IFN-gamma immunotherapy was seen and no IFI relapsed during long-term follow-up. Our experience is both uncontrolled and in patients with unpredictable fungal infection-related outcomes. However, compared to standard approaches, the accelerated cure of life threatening, disseminated IFIs with 6 weeks of combination antifungal drug therapy and IFN-gamma immunotherapy saved lives, retained allograft function and led to substantial cost savings in this small patient group.