Simulect和Zenapax应用于肾移植诱导治疗的5年临床观察

目的评价2剂Simulect和5剂Zenapax在肾移植中诱导治疗预防急性排斥反应（AR）的有效性、安全性以及对近、远期人／肾存活的影响。方法选择1999年4月～2001年4月首次肾移植患者102例，分成Simulect组（54例）和Zenapax组（48例），在三联免疫抑制剂基础上（环孢素A／FK506、骁悉、皮质激素）加用Simulect（术前2h和术后第4天分别予20mg静滴）或Zenapax（1mg·kg^-1·d^-1，最大剂量100mg，首剂术前2h，此后每2周1剂，共5剂）。观察术后3个月内肾功、AR、移植肾功能延迟恢复（DGF）、急性肾小管坏死情况；术后5年内肾功、排斥反应、并发症及人／肾存活情况。结果术后3个月内AR发生率明显降低（Simulect组：14．8％；Zenapax组：14．6％）；首次AR发生时间延迟；激素治疗对大部分AR有效；5年内再次排斥反应发生率为9．3％（Simulect组）和6．3％（Zenapax组）。术后肾功能恢复明显加快，早期及远期肾功能良好。未出现细胞因子释放综合征，仅2例DGF。5年内，感染、糖尿病、高脂血症、恶性肿瘤等未见增加。5年人／肾存活良好，均达95％以上。结论2剂Simulect和5剂Zenapax预防肾移植术后AR的效果好、安全性高，有利于早期肾功能恢复和远期人／肾存活。

Isolated small bowel transplantation outcomes and the impact of immunosuppressants: Experience of a single transplant center

AIM: To investigate patient and graft outcomes in isolated small bowel transplant(SBTx) recipients and immunosuppressant induction agent impact on outcomes.METHODS: A retrospective review of the perioperative data of patients who underwent SBTx transplant during an 8-year period was conducted. The intraoperative data were: patient demographics, etiology of short gut syndrome, hemodynamic parameters, coagulation profiles, intraoperative fluid and blood products transfused, and development of post-reperfusion. The postoperative data were: hospital/intensive care unit stays, duration of mechanical ventilation, postoperative incidence of acute kidney injury, and 1-year patient and graft outcomes. The effects of the three immunosuppressant induction agents(Zenapax, Thymoglobulin, Campath) on patient and graft outcomes were reviewed.RESULTS: During the 8-year period there were 77 patients; 1-year patient and graft survival were 95% and 86% respectively. Sixteen patients received Zenapax, 22 received Thymoglobulin, and 39 received Campath without effects on patient or graft survival(P = 0.90, P = 0.14, respectively). The use of different immune induction agents did not affect the incidence of rejection and infection during the first 90 postoperative days(P = 0.072, P = 0.29, respectively). The Zenapax group received more intraoperative fluid and blood products and were coagulopathic at the end of surgery. Zenapax and Thymoglobulin significantly increased serum creatinine at 48 h(P = 0.023) and 1 wk(P = 0.001) post-transplant, but none developed renal failure or required dialysis at the end of the first year.CONCLUSION: One-year patient and graft survival were 95% and 86%, respectively. The use of different immunosuppressant induction agents may affect the intraoperative course and short-term postoperative morbidities, but not 1-year patient and graft outcomes.

罗氏新药Zenapax对降低肾移植排异反应有效

美国马里兰州大学的Benjamin Philosophe博士5月9日在由美国移植学会(AST)和美国移植外科医生学会(AST)联合举办的美国移植专业会议上报告，他们的新药调查研究在对比两种治疗办法后指出，与另一种预防急性器官移植排异反应的药物OKT3(muromonab-CD3)比较，使用霍夫曼—罗氏(Hoffmann-La Roche)公司两个剂量的免疫抑制剂zenapax(R)(daclizumab)可以降低肾脏移植病人的移植器官排异反应所致的器官功能恢复延缓的风险，并且花费也较低。