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在儿童中进行无类固醇肝移植
Raymond Reding1, Jérémie Gras, Etienne Sokal
1Paediatric Liver Transplant Program, Université Catholique de Louvain, Saint-Luc University Clinics, 10 Hippocrate Avenue, 1200, Brussels, Belgium. reding@chex.ucl.ac.be
Lancet (London, England)
|December 31, 2003
概括
使用tacrolimus和basiliximab的无类固醇免疫抑制改善了儿科肝移植患者的无排斥生存率和生长率. 这种类固醇避开策略为传统的基于类固醇的疗法提供了一个安全的替代方案.
科学领域:
- 儿科移植 儿科移植
- 免疫抑制策略 免疫抑制策略
- 胃肠道学和肝病学
背景情况:
- 皮质类固醇是器官移植中免疫抑制疗法的长期组成部分.
- 人们对皮质类固醇的长期不良影响存在担忧,特别是在儿童群体中.
- 探索类固醇节约性免疫抑制对于改善儿科肝移植接受者的结果至关重要.
研究的目的:
- 评估儿童肝移植中无类固醇免疫抑制方案的疗效和安全性.
- 为了比较无排斥的生存率和无类固醇和基于类固醇的免疫抑制疗法之间的患者生长.
- 为了确定将塔克罗利斯与巴西利克西马布结合在一起是否是一种可行的类固醇节约替代品.
主要方法:
- 一项前性研究比较了20名儿科肝移植接受者在无类固醇治疗方案 (塔克罗利斯+巴西利克西马布) 和20名匹配的历史对照在类固醇治疗方案 (塔克罗利斯+类固醇) 上.
- 评估12个月的无排斥生存期作为主要结局.
- 在移植后的第一年对患者生长的评估.
主要成果:
- 无类固醇组 (塔克罗利斯+巴西利克西马布) 的12个月无排斥生存率为75%,而类固醇组的50% (p=0.05).
- 无类固醇组的患者在移植后的第一年表现出明显更好的生长.
- 在无类固醇组中没有发现不良事件的增加,这表明安全性.
结论:
- 在儿科肝移植中避免使用类固醇,使用tacrolimus和basiliximab的组合,是安全有效的.
- 与传统的基于类固醇的免疫抑制相比,这种无类固醇的方法可以改善无排斥的生存率和增强的生长.
- 塔克罗利马斯和巴西利西马布代表了在儿科肝移植中免疫抑制的有希望的类固醇节约替代品.
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