Advances in immunosuppression for pancreas transplantation
Advances in immunosuppression for pancreas transplantation
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胰腺移植免疫抑制研究进展
DOI：
10.1097/mot.0b013e3282f2fd91
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发表时间：
2008
影响因子：
2.2
通讯作者：
R. Stratta
中科院分区：
文献类型：
--
作者：
R. Singh;R. Stratta
综述目的对当前文献进行综述，以确定胰腺移植中临床免疫抑制的趋势并评估结果。最近的发现到2006年，在美国进行了超过20000例胰腺移植。自2000年以来，三种胰腺移植类型（胰肾联合移植、肾后序贯胰腺移植和单独胰腺移植）的1年患者生存率分别为95-97%，1年胰腺移植物生存率（完全不依赖胰岛素）分别为85%、78%和77%。一年排斥率稳步下降，目前在10-20%的范围内，这取决于病例组合和免疫抑制方案。目前，88%的受者接受抗体诱导，65%接受他克莫司/吗替麦考酚酯联合维持治疗，40-50%接受皮质类固醇停药而无不良后果。他克莫司/西罗莫司的有限数据显示了良好的短期结局，而钙调磷酸酶抑制剂避免或最小化的初始尝试则不太有希望。抗体诱导和他克莫司/吗替麦考酚酯或他克莫司/西罗莫司维持治疗伴激素停药已成为当代临床胰腺移植免疫抑制的主要方法。然而，开发一种无肾毒性、非糖尿病性和非胃肠毒性的治疗方案对于改善受者的预后和生活质量是非常必要的。
Purpose of reviewA review of current literature was performed to identify trends and evaluate outcomes with regard to clinical immunosuppression in pancreas transplantation. Recent findingsThrough 2006, over 20 000 pancreas transplantations were performed in the US. Since 2000, the 1-year patient survival rates for the three pancreas transplantation categories – simultaneous pancreas–kidney, sequential pancreas after kidney, and pancreas alone – were 95–97% and the 1-year pancreas graft survival (complete insulin independence) rates were 85%, 78%, and 77%, respectively. One-year rates of rejection have steadily decreased and are currently in the 10–20% range depending on case mix and immunosuppressive regimen. At present, 88% of recipients receive antibody induction, 65% receive maintenance therapy with the tacrolimus/mycophenolate mofetil combination, and 40–50% undergo corticosteroid withdrawal without adverse consequences. Limited data with tacrolimus/sirolimus reveal excellent short-term outcomes, whereas initial attempts with calcineurin inhibitor avoidance or minimization are less promising. SummaryAntibody induction and either tacrolimus/mycophenolate mofetil or tacrolimus/sirolimus maintenance therapy with steroid withdrawal have become the mainstay of contemporary immunosuppression in clinical pancreas transplantation. The development of a nonnephrotoxic, nondiabetogenic, and nongastrointestinal toxic regimen, however, is highly desirable to improve outcomes and quality of life in recipients.