Tacrolimus without antilymphocyte induction therapy prevents pancreas loss from rejection in 123 consecutive patients.
Tacrolimus without antilymphocyte induction therapy prevents pancreas loss from rejection in 123 consecutive patients.
复制标题
不进行抗淋巴细胞诱导治疗的他克莫司连续 123 名患者预防了因排斥反应引起的胰腺损失。
DOI：
10.1016/s0041-1345(97)01385-7
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发表时间：
1998
影响因子：
0.9
通讯作者：
Starzl,TE
中科院分区：
文献类型：
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作者：
Corry,RJ;Egidi,MF;Shapiro,R;Sugitani,A;Gritsch,HA;Jordan,ML;Dodson,SF;Vivas,CA;Scantlebury,VP;Rao,AS;Fung,JJ;Starzl,TE
方法分析1994年7月至1997年7月间123例胰腺移植患者的临床资料，其中106例合并肾移植。免疫抑制包括静脉注射他克莫司0.05 mg/kg，持续5 - 7天，随后初始口服剂量为0.15 mg/kg，每日两次。每日调整他可莫司剂量，以达到全血谷浓度20 - 25 ng/mL（前2周），1个月时达到15 - 20 ng/mL，3个月时达到10 - 15 ng/mL，6个月时达到7 - 12 ng/mL。患者还接受了逐渐减少的类固醇剂量和硫唑嘌呤在上半年的系列和霉酚酸酯在下半年。1例患者的生存率为98%，肾脏为94%，胰腺为83%（中位随访18个月）。3例患者在6、9和20个月时因慢性排斥反应而丧失移植物功能。1例患者高度致敏，术后淋巴细胞毒性交叉配型转为阳性，3周后因抗体介导的排斥反应而失去移植物。其他损失是非免疫性的，其中9个是继发于缺血/再灌注损伤，导致移植后几天内血栓形成。急性细胞排斥反应没有造成移植物丢失。在这一系列研究中，抗淋巴诱导治疗似乎对防止早期移植物因排斥反应而丢失没有必要。此外，我们还随访了巨细胞病毒（CMV）抗原血症（pp 65）的CMV感染。尽管在血清阳性到阴性的供体-受体组合中，一些患者出现了阳性抗原血症，但只有1例患者的发热病程延长1周。
METHODSThis report analyzes 123 consecutive patients who received pancreas transplants between July 1994 and July 1997, 106 in combination with kidney transplantation. Immunosuppression included intravenous tacrolimus 0.05 mg/kg for 5 to 7 days followed by an initial oral dose of 0.15 mg/kg twice a day. The tarcolimus dose was adjusted daily to achieve whole blood trough levels of 20 to 25 ng/mL (first 2 weeks), 15 to 20 by 1 month, 10 to 15 by 3 months, and 7 to 12 by 6 months. Patients also received tapering steroid doses and azathioprine during the first half of the series and mycophenolate mofetil during the second half. 1RESULTSSurvival rates were patient 98%, kidney 94%, and pancreas 83%(median follow-up 18 months). Three patients lost graft function at 6, 9, and 20 months from chronic rejection. One patient, who was highly sensitized and whose lympho-cytotoxic cross-match turned positive postoperatively, lost the graft at 3 weeks from an antibody-mediated rejection. Other losses were nonimmunologic, nine of which were secondary to an ischemic/reperfusion injury leading to thrombosis within a few days after transplantation. There were no losses from acute cellular rejection.SUMMARYIn this series, antilymphoid induction therapy did not appear to be necessary to prevent early graft loss from rejection. In addition, we have followed cytomegalovirus (CMV) antigenemia (pp65) for CMV infection. Although some patients developed a positive antigenemia in the seropositive to negative donor-recipient combinations, only one patient had a prolonged febrile course for 1 week.