Induction immunosuppressive therapies in renal transplantation
Induction immunosuppressive therapies in renal transplantation
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DOI：
10.2146/ajhp090636
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发表时间：
2011-02-01
影响因子：
2.7
通讯作者：
Grafals, Monica
中科院分区：
文献类型：
--
作者：
Gabardi, Steven;Martin, Spencer T.;Grafals, Monica
目的。本文综述了肾移植患者的诱导免疫抑制治疗。诱导治疗的目的是通过在移植时提供高度的免疫抑制来预防移植后早期的急性排斥反应。诱导治疗通常被认为是优化结果的关键，特别是在短期结果较差的高风险患者中。目前使用的所有诱导免疫抑制剂都是生物制剂，要么是单抗(muromonab-CD3、daclizumab、basiliximab、alemtuzumab)，要么是多克隆抗体(抗胸腺细胞球蛋白[马]或抗胸腺细胞球蛋白[兔])。虽然抗胸腺细胞球蛋白(兔)没有标记用于诱导治疗，但它比任何其他药物更多地用于这一目的。巴利昔单抗并不被认为是一种有效的免疫抑制剂，但与抗胸腺细胞球蛋白(兔)相比，它具有更有利的副作用，最常用于急性排斥反应风险较低的患者。利妥昔单抗正在被研究用于诱导治疗，但到目前为止还没有证明比安慰剂有任何显着的好处。虽然可以获得与大多数诱导剂相比较的面对面数据，但移植受者最合适的诱导治疗的最终决定高度依赖于先前存在的医疗条件、供体特征和将要使用的维持免疫抑制方案。目前尚无用于肾移植患者的标准诱导免疫抑制方案。抗胸腺细胞球蛋白(兔)是最常用的药物，而巴利昔单抗似乎更安全。方案的选择取决于临床医生和机构的偏好。
Purpose. Induction immunosuppressive therapies for patients undergoing renal transplantation are reviewed.Summary. The goal of induction therapy is to prevent acute rejection during the early posttransplantation period by providing a high degree of immunosuppression at the time of transplantation. Induction therapy is often considered essential to optimize outcomes, particularly in patients at high risk for poor short-term outcomes. All of the induction immunosuppressive agents currently used are biological agents and are either monoclonal (muromonab-CD3, daclizumab, basiliximab, alemtuzumab) or polyclonal (antithymocyte globulin [equine] or antithymocyte globulin [rabbit]) antibodies. Although antithymocyte globulin (rabbit) is not labeled for induction therapy, it is used for this purpose more than any other agent. Basiliximab is not considered as potent an immunosuppressive agent but has a much more favorable adverse-effect profile compared with antithymocyte globulin (rabbit) and is most commonly used in patients at low risk for acute rejection. Rituximab is being studied for use as induction therapy but to date has not demonstrated any significant benefits over placebo. While head-to-head data are available comparing most induction agents, the final decision on the most appropriate induction therapy for a transplant recipient is highly dependent on preexisting medical conditions, donor characteristics, and the maintenance immunosuppressive regimen to be used.Conclusion. No standard induction immunosuppressive regimen exists for patients undergoing renal transplantation. Antithymocyte globulin (rabbit) is the most commonly used agent, whereas basiliximab appears safer. The choice of regimen depends on the preferences of clinicians and institutions.