| The incidence of acute rejection episodes in cadaveric renal allograft recipients is up to 30%~80%, and about 80%~90% of acute rejection episodes occur in the first month after transplantation. Acute rejection has been associated with seriously bad short and long-term outcome, and the immunosuppressive agents have been used clinically to prevent acute rejection as the most important method at present. However, there are many immunosuppressive agents and immunosuppressive strategies with not only different clinical therapeutic effectiveness but also toxic and side effects to some extent. So how to select immunosuppressive strategy with fewer toxic and side effects, more excellent specificity and more effective immunosuppression to decrease the incidence of acute rejection episodes and toxicities of drugs is still the emphasis in the clinical transplantation nowadays. In recent years the triple maintenance immunosuppressive strategy with CsA, MMF and Pred has often been adopted in our renal transplant center, and different monoclonal antibodies such as Simulect, Zenapax or OKT3 also been separately used as additional induction therapy for some of renal allograft recipients in our center on the basis of the aforesaid triple maintenance therapy. According to different immunosuppressive strategies, renal allograft recipients in this study were divided into four groups: group A receiving CsA, MMF, Pred and Simulect; group B receiving CsA, MMF, Pred and Zenapax; group C receiving CsA, MMF, Pred and OKT3; group D receiving CsA, MMF and Pred. In the first part of this study, the acute rejection episodes, recovery of renal function, survival rates of grafts and patients and main side effects in 273 recipients received respectively one of aforesaid immunosuppressive strategies within 3 months after transplantation were analyzed retrospectively to evaluate the therapeutic effectiveness and concerned safety of different immunosuppressive strategies and to summarize more ideal immunosuppressive strategy for doctors in clinical renal transplantation to select more appropriate immunosuppressive agents; In the second part of the study, blood IL-2 and sIL-2R of 47 renal recipientsreceived aforementioned immunosuppressive strategies within 2 months after transplantation were observed prospectively, and the suppressive effects of the different immunosuppressive strategies on recipients' blood IL-2 and sIL-2R were analyzed according to the changes observed.The main results are as follows: In the first part: the incidences of acute rejection episodes in group A (n=43), group B (n=46), group C (n=88) and group D(n=96) were 9.3%(4/43), 8.7%(4/46), 23.9%(21/88)and 37.5%(36/96) respectively. The incidences in group A and B were lower than in group C (P<0.05)and significantly lower than in group D(P<0.001), and incidence in group C lower than in group D(P=0.046). The rates of second/steroid-resistant first rejection episodes in group C and D were 2.3%/5.7% and 5.2%/11.5% respectively. The time of first rejection episodes in four groups was on the 41.0±5.48, 44.3±6.24, 22.0±6.12 and 10.5±5.34 day after transplantation respectively, and the time for renal function to recover was 4.7±2.12, 4.9±2.06, 8.6±5.17 and 13.1±6.07 days respectively. The effects on prolonging rejection episodes and speeding up recovery of renal function in group A and B were significantly better than in group C and D(P<0.001), and that in group C better than in group D(P<0.001). The infection rates in four groups were 16.3%(7/43), 17.4%(8/46), 27.3%(24/88)and 15.6%(15/96) respectively. The incidence of cytokine release syndrome in group C was 51.8%(45/88). No malignant tumor in four groups, and graft/patient survival rate in each group was 100%.In the second part: The range of reduced concentration of sIL-2R at the fourth hour after transplantation in group B(n=20), group C (n=12) and group D (n=15) was 6815.10±1369.789, 3151.80±986.958 and 2978.27±812.591 pg/ml respectively, and effect on reducing sIL-2R in group B was m...
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