Single dose of alemtuzumab induction with steroid-free maintenance immunosuppression in pancreas transplantation.
Single dose of alemtuzumab induction with steroid-free maintenance immunosuppression in pancreas transplantation.
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胰腺移植中单剂量阿仑单抗诱导与无类固醇维持免疫抑制。
DOI：
10.1097/tp.0b013e31822b58be
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发表时间：
2011
期刊：
影响因子：
6.2
通讯作者：
Kadry,Zakiyah
中科院分区：
文献类型：
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作者：
Uemura,Tadahiro;Ramprasad,Varun;Matsushima,Kazuhide;Shike,Hiroko;Valania,Tracy;Kwon,Osun;Ghahramani,Nasrollah;Shah,Riaz;Farooq,Umar;Khan,Akhtar;Kadry,Zakiyah
背景。阿仑妥珠单抗（人源抗cd52单克隆抗体）在肾移植中的应用已经有了初步的研究，阿仑妥珠单抗诱导胰腺移植的经验仍然有限。在2006年11月至2010年4月期间，我们共进行了28例胰腺移植手术（17例肾胰联合移植[SPK]， 5例肾移植后胰腺移植[PAK]， 6例单独胰腺移植[PTA]）。中位随访为25个月（范围8-49个月）。维护性免疫抑制包括他克莫司和霉酚酸盐。我们分析了患者/移植物的存活率、移植物功能和并发症。SPK、PAK和PTA的1年精算患者/移植物生存率为100%/100%。SPK、PAK和PTA的3年精算患者/胰腺移植生存率分别为100%/100%、100%/100%和100%/83%。胰腺和肾脏移植功能良好。42%的患者发生急性细胞排斥反应。大多数排斥反应发生在移植后大约1或6个月。移植后1年的绝对淋巴细胞计数低于术前水平，移植后3年的白细胞计数明显低于移植前水平。巨细胞病毒感染和细菌感染发生率分别为28%和36%。结论单剂量30mg阿仑单抗诱导无类固醇维持性免疫抑制治疗胰腺移植患者和移植物中期生存良好，并发症发生率可接受。
Background.The use of alemtuzumab (humanized anti-CD52 monoclonal antibody) has been primarily studied in renal transplantation, and the experience of alemtuzumab induction in pancreas transplantation is still limited. The objective of this study is to analyze the outcome of pancreas transplantation by using a single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression.Methods.We performed a total 28 pancreas transplants (17 simultaneous kidney-pancreas transplantation [SPK], 5 pancreas after kidney transplantation [PAK], and 6 pancreas transplant alone [PTA]) between November 2006 and April 2010. Median follow-up was 25 months (range, 8–49 months). Maintenance immunosuppression consists of tacrolimus and mycophenolate. We analyzed patient/graft survival, graft function, and complications.Results.One-year actuarial patient/graft survival was 100%/100% in SPK, PAK, and PTA. Three-year actuarial patient/pancreas graft survival rates for SPK, PAK, and PTA were 100%/100%, 100%/100%, and 100%/83%, respectively. Excellent pancreas and kidney graft functions were observed. Acute cellular rejection occurred in 42% of patients. Most of the rejection episode occurred approximately 1 or 6 months after transplant. Absolute lymphocyte count remained below preoperative level for 1 year posttransplant and WBC counts were significantly lower for 3 years after transplant compared with pretransplant level. Cytomegalovirus infection and bacterial infection occurred in 28% and 36% of patients, respectively. Eleven percent of patients developed donor-specific antibodies and 7% of patients experienced antibody-mediated rejection.Conclusion.A single dose of 30 mg alemtuzumab induction with steroid-free maintenance immunosuppression achieved excellent mid-term patient and graft survival for pancreas transplantation with acceptable complication rate.