LONG-TERM RESULTS OF A CONTROLLED PROSPECTIVE-STUDY WITH TRANSFUSION OF DONOR-SPECIFIC BONE-MARROW IN 57 CADAVERIC RENAL-ALLOGRAFT RECIPIENTS
LONG-TERM RESULTS OF A CONTROLLED PROSPECTIVE-STUDY WITH TRANSFUSION OF DONOR-SPECIFIC BONE-MARROW IN 57 CADAVERIC RENAL-ALLOGRAFT RECIPIENTS
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DOI：
10.1097/00007890-199101000-00011
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发表时间：
1991-01-01
期刊：
影响因子：
6.2
通讯作者：
DIETHELM, AG
中科院分区：
文献类型：
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作者：
BARBER, WH;MANKIN, JA;DIETHELM, AG
实验研究表明，抗淋巴细胞球蛋白联合输注供者特异性骨髓细胞可诱导对同种异体移植组织的部分耐受。我们已经将这些方案应用于临床，并报告了57例身体肾移植受者接受明尼苏达州ALG后输注冷冻保存的供者特定骨髓的结果。对照组54例，接受对侧肾移植及类似免疫抑制治疗，不输注骨髓。两组均接受MALG、环孢素、硫唑嘌呤和泼尼松的四重免疫抑制治疗。骨髓组在ALG诱导10~14d后，于末次ALG后第7d输注冻存骨髓。两组中位随访期均为16个月(2.5-33个月)。骨髓组共丢失移植物6例(3例排斥，2例死亡[Cr2.0，2.3]，1例复发)。对照组移植血管丢失16例(13例排斥，3例死亡[Cr1.7.2.5，3.0])。对照组中有5名患者有活检证实的慢性排斥反应，而骨髓组只有1名。骨髓组的17名患者已经逐渐停用强的松，其中3名患者出现了轻微的晚期排斥反应，没有移植物丢失。比较两组排斥反应次数、估计的肾血浆流量、肾小球滤过率和尿蛋白的差异。未发现差异。骨髓组的移植物存活率显著高于对照组(P<；.01)。骨髓组12个月和18个月的移植物存活率分别为90%(可信区间85~94)和85%(CL 78~90)。对照组移植肾12个月和18个月存活率分别为71%(CL 63-78)和67%(CL 58-74)。对照组的存活率与我们接受四联疗法的整体移植经验相似。混合淋巴细胞培养分析显示，骨髓组的供者特异性反应性有降低的趋势。在身体肾移植受者中，使用冷冻保存的供者特定的骨髓与提高移植物存活率有关。然而，需要一种更有效的诱导方案来减少排斥反应的总次数。
Experimental studies have shown that antilymphocyte globulin combined with transfusion of donor-specific bone marrow cells can induce partial tolerance to allograft tissue. We have adapted these protocols to clinical use and present the results of 57 cadaveric renal allograft recipients who received Minnesota ALG followed by the transfusion of cryopreserved donor-specific bone marrow. A group of 54 patients received the contralateral kidney and similar immunosuppression without the marrow transfusion and serve as controls. Both groups received quadruple immunosuppression with MALG, cyclosporin, azathioprine, and prednisone. In the bone marrow group, after a 10-14-day induction course of ALG, cryopreserved marrow was transfused on the seventh day after the last dose of ALG. The median follow-up in both groups is 16 months, (range 2.5-33 months). Six grafts have been lost in the bone marrow group, (three rejections, 2 deaths [Cr 2.0, 2.3], 1 recurrent disease). In the control group 16 grafts have been lost (13 rejections, 3 deaths [Cr 1.7.2.5, 3.0]). Five patients in the control group have biopsy-proved chronic rejection compared to one in the bone marrow group. 17 patients in the bone marrow group have been tapered off the prednisone, and three of these patients have had mild late rejection episodes without graft loss. The two groups were compared for differences in the number of rejection episodes, estimated renal plasma flow, glomerular filtration rate, and urine protein. No differences were found. The allograft survival of the bone marrow group was significantly greater (P < .01) than the control group. The graft survival rates for the bone marrow group at 12 and 18 months were 90% (confidence limits [CL] 85-94) and 85% (CL 78-90), respectively. In the the control group the 12 and 18 month allograft survival rates were 71% (CL 63-78) and 67% (CL 58-74), respectively. The survival in the control group was similar to our overall transplant experience with quadruple therapy. Mixed lymphocyte culture analysis shows a trend to diminished donor-specific responsiveness in the bone marrow group. The use of cryopreserved donor-specific bone marrow is associated with improved allograft survival in cadaveric kidney allograft recipients. However, a more effective induction protocol is needed to reduce the overall number of rejection episodes.