巴利昔单抗联合鼠抗人CD3单克隆抗体在高致敏受者肾移植中的临床应用

摘要

OBJECTIVE: To study the efficacy and safety of basiliximab combined with mouse CD3 monoclonal antibody (OKT3) in hypersensitive recipients underwent renal transplantation. METHODS: 2 months before operation, 20 cadaveric donor renal transplantations were performed in patients with high panel reactive antibodies (PRA levels >50%). All patients received basic immunosuppression therapy with Tac, MMF, and Pred. 9 patients received prophylactic basiliximab combined with OKT3 (combined induction group), and 11 received standard-dose OKT3 (OKT3 induction group). The recovery of transplanted kidney function after operation, the incidence of acute rejection within 3 months, pulmonary infection and survival rate of human/kidney and renal transplantation function 1 year after operation were all evaluated. RESULTS: The incidence of acute rejection episodes of combined induction group vs. OKT3 induction group were 11.1% vs. 36.4% (P=0.319), and the incidence of pulmonary infection in both groups were 11.1% vs. 63.6% (P=0.028); the proportion of renal function returned normal in combined induction group within 1 week were significantly higher than in OKT3 induction group (88.9% vs. 27.3% ,P=0.010). The survival rate of human/kidney 1 year after operation reached 100% in combined induction group, there was no significant difference between combined induction group and OKT3 induction group (90.9% ,81.8% ,P= 1.00,P=0.100). The serum creatinine of combined induction group arid OKT3 induction group were (105±24)μmoI·L‐1 and (97±22)μmol·L‐1(P=0.437) 1 year after operation. CONCLUSION: The combined use of prophylactic basiliximab and OKT3 can prevent rejection in the early stage, shorten the duration of renal function recovery and seems to offer a safe and effective strategy for induction therapy in hypersensitive patients receiving renal transplantation.%目的:探讨巴利昔单抗与鼠抗人CD3单克隆抗体(OKT3)联合诱导在高致敏受者肾移植临床应用中的有效性及安全性.方法:术前2个月内群体反应性抗体(PRA)检测值均＞50％的尸体供肾肾移植受者20例,其中9例受者接受巴利昔单抗联合OKT3免疫诱导(联合诱导组),11例受者接受OKT3常规免疫诱导(OKT3诱导组),均以他克莫司(Tac)+吗替麦考酚酯(MMF)+泼尼松(Pred)为基础免疫抑制方案,评估术后移植肾功能恢复情况、3个月内急性排斥反应发生率、1年内肺部感染发生率、1年人/肾存活率及移植肾功能.结果:联合诱导组、OKT3诱导组肾移植术后3个月内急性排斥反应发生率及术后1年内肺部感染发生率分别为11.1％ vs.36.4％ (P=0.319),11.1％ vs.63.6％ (P=0.028)；联合诱导组患者术后1周内移植肾功能恢复正常比例明显高于OKT3诱导组(88.9％ vs.27.3％,P=0.010)；联合诱导组术后1年人/肾存活率均为100％,与OKT3诱导组(分别为90.9％、81.8％)比较,差异不显著(P=1.00和P=0.100)；术后1年联合诱导组、OKT3诱导组血肌酐值分别为(105±24)、(97±22) μmol·L-1(p=0.437).结论:巴利昔单抗联合OKT3进行免疫诱导,在预防高致敏受者术后早期排斥反应的同时,缩短了移植肾功能的恢复时间,是一种安全、有效的防治策略.