Steroid-free immunosuppression in renal transplantation - A long-term follow-up of 100 consecutive patients
Steroid-free immunosuppression in renal transplantation - A long-term follow-up of 100 consecutive patients
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DOI：
10.1097/00007890-200104270-00013
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发表时间：
2001-04-27
期刊：
影响因子：
6.2
通讯作者：
Birkeland, SA
中科院分区：
文献类型：
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作者：
Birkeland, SA
背景。我们在临床肾移植中的目标是建立一种无类固醇的免疫抑制方案，不仅可以促进患者和移植物的长期生存，还可以改善患者的整体健康。在一项前瞻性、非随机、临床研究中，1996-1999年，100名连续接受第一次和第二次移植物移植的患者带着功能正常的移植物从我们的中心出院，随访长达4年半。患者接受无类固醇免疫抑制，初始10天抗胸腺细胞（ATG）诱导和维持治疗，使用环孢素（CsA）和霉酚酸酯（MMF）。没有使用类固醇。在长达4年半的观察时间后，观察到1年、2年、3年和4年的移植物存活率分别为97%、96%、90%和82%，与hla匹配、肾脏疾病、供者年龄或类型或移植次数无关。99例患者（1例死亡或返透析后腹膜炎）生存良好。90例移植物功能良好，9例因溶血性尿毒症综合征复发而再次透析，7-36个月后出现肾小球肾炎2例，慢性排斥反应7例（7-30个月后不遵规定3例）。所有7名15岁以下的儿童都存活，移植物功能良好，除了1名肾小球肾炎复发，他在两年半后再次接受透析。急性排斥13例（13%），早期排斥10例（前3个月）（10%），晚期排斥3例（6-42个月）（3%）。所有急性排斥反应均成功逆转。未见淋巴瘤。我们的一线无类固醇免疫抑制方案允许初始移植物功能，提供安全水平的长期移植物存活和功能，排异率极低，副作用率可接受，并具有长期降低慢性排斥发生率的潜力。与在移植后最初阶段停止使用类固醇的方案相比，无类固醇方案避免了移植后早期感染、身体毁容和其他类固醇引起的副作用的增加风险，也避免了类固醇使用的长期风险和停药后排斥反应的增加风险。
Background. Our goal in clinical renal transplantation is to establish a steroid-free immunosuppressive protocol that not only promotes long-term patient and graft survival, but also improves the overall well-being of the patients.Methods. In a prospective, nonrandomized, clinical study 100 consecutive patients transplanted with first and second grafts were discharged from our center with functioning grafts 1996-1999 and followed for up to 4 1/2 years. Patients received steroid-free immunosuppression with an initial 10-day antithymocyte (ATG) induction and maintenance therapy with cyclosporine (CsA) and mycophenolate mofetil (MMF). No steroids were given.Results. After an observation time of up to 4 1/2 years, 1-, 2-, 3-, and 4-year graft survivals of 97, 96, 90, and 82% were observed, with no correlation to HLA-matching, kidney disease, donor age or type, or number of transplants. Ninety-nine patients (1 died or peritonitis after returning to dialysis) were alive and well. Ninety grafts were functioning well, 9 patients returned to dialysis due to recurrence of hemolytic uremic syndrome, and glomerulonephritis in 2 and chronic rejection in 7 grafts after 7-36 months (3 due to non-compliance after 7-30 months). All 7 children below the age of 15 are alive, with well-functioning grafts, except 1 with recurrence of glomerulonephritis who returned to dialysis after 2 1/2 years. There were 13 acute rejections (13%), 10 early (first 3 months) (10%), and 3 late (6-42 months) (3%). All acute rejection episodes were successfully reversed. No lymphomas were observed.Conclusions. Our first-line, steroid-free immunosuppressive protocol allows initial graft function, provides a safe level of long-term graft survival and function with a very low rejection rate, gives an acceptable rate of side effects, and possesses the potential for lowering the incidence of chronic rejection over the long-term. Compared with protocols that discontinue steroids after the initial posttransplant period, a steroid-free protocol avoids the increased risk of infection, body disfigurement, and other steroid-induced side-effects in the early posttransplant period, It also avoids the long-term risks of steroid use and the increased risk of rejection when the steriods are withdrawn.