摘要
目的观察巴利昔单抗联合减激素免疫抑制方案在供受者血型相容儿童肝移植中的疗效。方法前瞻性将2019年1月1日至2020年1月19日在天津市第一中心医院收治的150例供受者血型相容儿童肝移植受者按数字随机法分为实验组(75例)与对照组(75例),实验组采用巴利昔单抗联合术中单次糖皮质激素诱导,术后单用他克莫司抗排斥方案,对照组采用常规剂量糖皮质激素诱导,术后联合应用他克莫司和糖皮质激素抗排斥方案。分析比较两组受者的临床特征、术后受者/移植肝存活率、排斥反应发生率和感染发生率的差异性。结果150例受者术后随访时间为9.2个月(0.7~15.5个月)。两组受者在肝移植3个月和1年累积存活率、急性排斥反应发生率、术后早期肺部感染发生率、巨细胞病毒及EB病毒发生率方面的差异均无统计学意义。进一步分层发现实验组中活体肝移植的56例受者中6例(10.7%)出现急性排斥反应,对照组中活体肝移植的47例受者中12例(25.5%)出现急性排斥反应,实验组中活体肝移植受者急性排斥反应发生率较低,差异有统计学意义(P=0.043)。结论巴利昔单抗联合减量糖皮质激素免疫抑制方案可安全应用于供受者血型相容儿童肝移植受者,可降低活体肝移植儿童受者的急性排斥反应。
Objective To evaluate the efficacy of basiliximab plus single steroid induced immunotherapy during donor-recipient ABO-compatible pediatric liver transplantation(LT).Methods From January 1,2019 to January 19,2020,a total of 150 children of donor-recipient ABO-compatible LT were randomly divided into basiliximab group(basiliximab plus single steroid induction and postoperative immunosuppression with tacrolimus alone)and steroid group(conventional dose of steroid induction plus postoperative immunosuppression with tacrolimus and steroid).Clinical characteristics,survival rate of recipients and liver allografts,rejection rate and infection rate were observed.Results The median follow-up time was 9.2(0.7~15.5)months.No significant inter-group differences existed in survival rate of recipients/grafts or the incidence of acute rejection,early postoperative pulmonary infection,cytomegalovirus and Epstein Barr virus infection.However,in 56 living donor LT,acute rejection(6cases,10.7%)occurred in basiliximab group versus(12cases,25.5%)in steroid group.During living donor LT,the incidence of acute rejection declined markedly in bsiliximab group as compared with steroid group(P=0.043).Conclusions Both safe and effective for donor-recipient ABO-compatible pediatric LT,basiliximab plus single steroid induced immunotherapy can significantly lower the occurrences of acute rejection during living donor LT.
作者
董冲
孙超
陈静
郑卫萍
覃虹
王凯
杨洋
张复波
韩潮
高伟
Dong Chong;Sun Chao;Chen Jing;Zheng Weiping;Qing Hong;Wang Kai;Yang Yang;Zhang Fubo;Han Chao;Gao Wei(Pediatric organ transplantation,Tianjin First Central Hospital,Tianjin organ transplantation Key Laboratory,Tianjin organ transplantation clinical medical research center,Tianjin 300192,China)
出处
《中华器官移植杂志》
CAS
2021年第3期136-140,共5页
Chinese Journal of Organ Transplantation
基金
天津市卫生健康委员会重点攻关课题(16KGl07)。
