抗CD3单克隆抗体在预防肾移植术后急性排斥反应中的作用

目的 :观察抗CD3单克隆抗体在预防肾移植术后急性排斥反应的作用。方法 :16 4例肾移植患者分为两组 ,4 2例移植术后应用抗CD3单克隆抗体 (5mg d)为治疗组 ;其它 12 2例为对照组。观察移植术后人 肾存活率、急性排斥反应及CMV感染的发生率。结果 :治疗组 1年、2年及 3年人存活率与对照组无显著差异 ,而治疗组移植肾存活率明显高于对照组(P <0 0 5 )。治疗组急性排斥反应发生率 (18 6 % )比对照组 (2 8 7% )低 ,P <0 0 5 ,且首次急性排斥反应发生时间明显延长 ,对MP冲击治疗效果好。治疗组CMV感染的发生率 (33 3% )高于对照组 ,P <0 0 5。结论 :肾移植术后预防性使用抗CD3单克隆抗体对提高移植肾存活率 ,降低急性排斥反应发生率有较好的作用 ;用药期间应注意预防及治疗CMV感染。

Clinical experience of using anti-CD3 monoclonal antibody to prevent allograft rejection episodes after renal transplantation

Objective:To study the effect of anti CD3 monoclonal antibody on preventing acute rejection episodes after renal transplantation.Methods:42 patients undergoing renal transplantation were treated with anti CD3 monoclonal antibody (5 mg) daily for a mean of 10 days (treated group).122 patients who were not treated with anti CD3 monoclonal antibody (control group).Acute rejection episodes,graft loss,death and rate of CMV infection in patients were observed.Results:The treated group had a significantly reduced risk of acute rejection (18 6%),as compared with the control group (28 7%).The rate of graft loss were significantly reduced in the treated group 1 year,2 years,or 3 years after renal transplantation.There were no significant differences in mortality between treated group and control group 1 year,2 years,or 3 years after renal transplantation.The incidence rate of CMV infection were significantly increased in the treated group (33 3%),as compared with the control group (13 9%).The first acute rejection episode was postponed significantly in the treated group.There were more acute rejection episodes that could be reversed by MP in the treated group.Conclusion:Anti CD3 monoclonal antibody significantly reduced the risk of acute rejection and significantly reduced the rate of graft loss.Anti CD3 monoclonal antibody significantly increased the incidence rate of CMV infection,which should be paid attention.