BACKGROUND： The benefits of the application of basiliximab induction therapy in liver transplantation are not clear. The present meta-analysis was to evaluate the pros and cons of basiliximab use in liver transplanta...BACKGROUND： The benefits of the application of basiliximab induction therapy in liver transplantation are not clear. The present meta-analysis was to evaluate the pros and cons of basiliximab use in liver transplantation. DATA SOURCES： We searched the associated publications in English from July 1998 to December 2015 in the following databases： MEDLINE, Pub Med, Ovid, EMBASE, Web of Science and Cochrane Library.RESULTS： Basiliximab significantly decreased the incidence of de novo diabetes mellitus after liver transplantation（RR=0.56; 95% CI： 0.34-0.91; P=0.02）. Subgroup analysis showed that basiliximab in combination with steroids-free immunosuppressant significantly decreased the incidence of biopsy-proven acute rejection（RR=0.62; 95% CI： 0.39-0.97; P=0.04） and new-onset hypertension（RR=0.62; 95% CI： 0.42-0.93; P=0.02）.CONCLUSIONS： Basiliximab may be effective in reducing de novo diabetes mellitus. What is more, basiliximab in combination with steroids-free immunosuppressant shows statistical benefit to reduce biopsy-proven acute rejection and de novo hypertension.展开更多
Objective To investigate the effectiveness and tolerability of immunosuppressive regimen with daclizumab induction therapy. Methods In study group,139 patients received immunosuppressive regimen with daclizumab induct...Objective To investigate the effectiveness and tolerability of immunosuppressive regimen with daclizumab induction therapy. Methods In study group,139 patients received immunosuppressive regimen with daclizumab induction therapy. In historical control group,展开更多
Background Induction therapy are utilized to achieve an adequate immunosuppression at the time of transplantation. The use of basiliximab or anti-thymocyte globulin （ATG） for induction therapy has significantly redu...Background Induction therapy are utilized to achieve an adequate immunosuppression at the time of transplantation. The use of basiliximab or anti-thymocyte globulin （ATG） for induction therapy has significantly reduced the incidence of acute rejection episodes post-transplantation. The purpose of this study was to compare the efficacy and safety of the basiliximab in patients with immuno-induction therapy after kidney transplantation with the ATG. Methods A retrospective analysis was carried out in kidney transplant recipients including 146 patients with the basiliximab and 116 cases with the ATG and the acute rejection, graft function, infective complications and 1-year and 5-year actuarial patient and graft survival after renal transplantation were compared between the two treatment groups. Results There were no statistically significant difference between groups regarding age, sex, cold ischemic time, warm ischemic time, human leukocyte antigen （HLA） matching type between the donor and recipient, lymphotoxin test and the use of immunosuppressive agents. There was no statistical significance regarding the incidence of the acute rejection （9.59% vs. 8.62%, P=0.481） and delayed graft function （10.27% vs. 9.48%, P=0.501） between groups. There were significantly lower lung infection incidence （5.48% vs. 12.93%, P=0.029） in the basiliximab-treated group in comparison with the ATG-treated group. One-year patient and graft survival rates were 98%, 97% for the basiliximab-treated group, and 95%, 73% for the ATG-treated group, respectively. Five-year patient and graft survival rates were 92%, 86% for the basiliximab-treated group and 93%, 72% for the ATG-treated group, respectively. Log rank test showed statistically significant difference with P=0.038 for patients and P=-0.033 for grafts, respectively. There were significantly lower the incidence of granulocytopenia （8.22% vs. 17.24%, P=0.022） and thrombocytopenia （4.11% vs. 19.83%, P=0.000） after transplantation in the basiliximab-treated group in comparison with the ATG-treated group. There was no statistical significance regarding the incidence of the heart dysfunction after transplantation between the two groups （6.16% vs. 6.90%, P=0.502）. Conclusion The immuno-induction therapy with the basiliximab in kidney transplant recipients is efficient and safe with less complication compared with the ATG.展开更多
目的:肝移植受者术后感染率高,识别出具有细菌与真菌感染高风险的患者将有利于预防疾病和改善肝移植受者的长期预后。本研究旨在了解肝移植术后早期(2个月内)细菌及真菌感染的病原菌组成、分布和预后,并分析其危险因素。方法:收集2020年...目的:肝移植受者术后感染率高,识别出具有细菌与真菌感染高风险的患者将有利于预防疾病和改善肝移植受者的长期预后。本研究旨在了解肝移植术后早期(2个月内)细菌及真菌感染的病原菌组成、分布和预后,并分析其危险因素。方法:收集2020年5月至2021年10月在中南大学湘雅三医院行肝移植手术的受者发生细菌与真菌感染的病原体组成、分布和预后的数据,并分析感染发生的危险因素。结果:105例肝移植受者中75例发生了106株细菌或真菌感染,肝移植术后早期感染发生率为71.4%(75/105)。病原菌构成中G-杆菌处于优势(49/106,46.2%),G+球菌次之(31/106,29.2%)。G-杆菌中最常见者为鲍曼不动杆菌(13/106,12.3%)。G+球菌中最常见者为屎肠球菌(20/106,18.9%)。最常见感染部位为肺部感染(38/105,36.2%)及多部位感染(30/105,28.6%)。术后死亡6例(6/105,5.7%),均为感染患者。单因素分析显示术前终末期肝病模型(model for end stage liver disease,MELD)评分、术前半个月内抗生素使用、术前2个月内感染、术中红细胞输注量≥8 U、术后导尿管留置≥4 d及使用巴利昔单抗≥40 mg与感染发生有关;多元logistic回归分析显示仅术前两个月内感染(OR=5.172,95%CI:1.905~14.039,P<0.01)是肝移植术后细菌与真菌感染发生的独立危险因素,使用巴利昔单抗≥40 mg(OR=0.197,95%CI:0.051~0.762,P<0.05)的肝移植受者术后细菌与真菌感染率降低。结论:肝移植术后早期细菌与真菌感染发生率高,感染后病死率明显高于非感染患者,最常见感染部位为肺部,最多见病原体为G-杆菌。术前2个月内感染的受者术后易发生细菌与真菌感染。规范使用巴利昔单抗有助于减少肝移植术后感染的发生。展开更多
Antibody induction therapy is frequently used as an adjunct to the maintenance immunosuppression in adult kidney transplant recipients. Published data support antibody induction in patients with immunologic risk to re...Antibody induction therapy is frequently used as an adjunct to the maintenance immunosuppression in adult kidney transplant recipients. Published data support antibody induction in patients with immunologic risk to reduce the incidence of acute rejection(AR) and graft loss from rejection. However, the choice of antibody remains controversial as the clinical studies were carried out on patients of different immunologic risk and in the context of varying maintenance regimens. Antibody selection should be guided by a comprehensive assessment of immunologic risk, patient comorbidities, financial burden as well as the maintenance immunosuppressives. Lymphocyte-depleting antibody(thymoglobulin, ATGAM or alemtuzumab) is usually recommended for those with high risk of rejection, although it increases the risk of infection and malignancy. For low risk patients, interleukin-2 receptor antibody(basiliximab or daclizumab) reduces the incidence of AR without much adverse effects, making its balance favorable in mostpatients. It should also be used in the high risk patients with other medical comorbidities that preclude usage of lymphocyte-depleting antibody safely. There are many patients with very low risk, who may be induced with intravenous steroids without any antibody, as long as combined potent immunosuppressives are kept as maintenance. In these patients, benefits with antibody induction may be too small to outweigh its adverse effects and financial cost. Rituximab can be used in desensitization protocols for ABO and/or HLA incompatible transplants. There are emerging data suggesting that alemtuzumab induction be more successful than other antibody for promoting less intensive maintenance protocols, such as steroid withdrawal, tacrolimus monotherapy or lower doses of tacrolimus and mycophenolic acid. However, the long-term efficacy and safety of these unconventional strategies remains unknown.展开更多
基金supported by a grant from the Science and Technology project of Shenyang(F13-212-9-00)
文摘BACKGROUND： The benefits of the application of basiliximab induction therapy in liver transplantation are not clear. The present meta-analysis was to evaluate the pros and cons of basiliximab use in liver transplantation. DATA SOURCES： We searched the associated publications in English from July 1998 to December 2015 in the following databases： MEDLINE, Pub Med, Ovid, EMBASE, Web of Science and Cochrane Library.RESULTS： Basiliximab significantly decreased the incidence of de novo diabetes mellitus after liver transplantation（RR=0.56; 95% CI： 0.34-0.91; P=0.02）. Subgroup analysis showed that basiliximab in combination with steroids-free immunosuppressant significantly decreased the incidence of biopsy-proven acute rejection（RR=0.62; 95% CI： 0.39-0.97; P=0.04） and new-onset hypertension（RR=0.62; 95% CI： 0.42-0.93; P=0.02）.CONCLUSIONS： Basiliximab may be effective in reducing de novo diabetes mellitus. What is more, basiliximab in combination with steroids-free immunosuppressant shows statistical benefit to reduce biopsy-proven acute rejection and de novo hypertension.
文摘Objective To investigate the effectiveness and tolerability of immunosuppressive regimen with daclizumab induction therapy. Methods In study group,139 patients received immunosuppressive regimen with daclizumab induction therapy. In historical control group,
文摘Background Induction therapy are utilized to achieve an adequate immunosuppression at the time of transplantation. The use of basiliximab or anti-thymocyte globulin （ATG） for induction therapy has significantly reduced the incidence of acute rejection episodes post-transplantation. The purpose of this study was to compare the efficacy and safety of the basiliximab in patients with immuno-induction therapy after kidney transplantation with the ATG. Methods A retrospective analysis was carried out in kidney transplant recipients including 146 patients with the basiliximab and 116 cases with the ATG and the acute rejection, graft function, infective complications and 1-year and 5-year actuarial patient and graft survival after renal transplantation were compared between the two treatment groups. Results There were no statistically significant difference between groups regarding age, sex, cold ischemic time, warm ischemic time, human leukocyte antigen （HLA） matching type between the donor and recipient, lymphotoxin test and the use of immunosuppressive agents. There was no statistical significance regarding the incidence of the acute rejection （9.59% vs. 8.62%, P=0.481） and delayed graft function （10.27% vs. 9.48%, P=0.501） between groups. There were significantly lower lung infection incidence （5.48% vs. 12.93%, P=0.029） in the basiliximab-treated group in comparison with the ATG-treated group. One-year patient and graft survival rates were 98%, 97% for the basiliximab-treated group, and 95%, 73% for the ATG-treated group, respectively. Five-year patient and graft survival rates were 92%, 86% for the basiliximab-treated group and 93%, 72% for the ATG-treated group, respectively. Log rank test showed statistically significant difference with P=0.038 for patients and P=-0.033 for grafts, respectively. There were significantly lower the incidence of granulocytopenia （8.22% vs. 17.24%, P=0.022） and thrombocytopenia （4.11% vs. 19.83%, P=0.000） after transplantation in the basiliximab-treated group in comparison with the ATG-treated group. There was no statistical significance regarding the incidence of the heart dysfunction after transplantation between the two groups （6.16% vs. 6.90%, P=0.502）. Conclusion The immuno-induction therapy with the basiliximab in kidney transplant recipients is efficient and safe with less complication compared with the ATG.
文摘目的:肝移植受者术后感染率高,识别出具有细菌与真菌感染高风险的患者将有利于预防疾病和改善肝移植受者的长期预后。本研究旨在了解肝移植术后早期(2个月内)细菌及真菌感染的病原菌组成、分布和预后,并分析其危险因素。方法:收集2020年5月至2021年10月在中南大学湘雅三医院行肝移植手术的受者发生细菌与真菌感染的病原体组成、分布和预后的数据,并分析感染发生的危险因素。结果:105例肝移植受者中75例发生了106株细菌或真菌感染,肝移植术后早期感染发生率为71.4%(75/105)。病原菌构成中G-杆菌处于优势(49/106,46.2%),G+球菌次之(31/106,29.2%)。G-杆菌中最常见者为鲍曼不动杆菌(13/106,12.3%)。G+球菌中最常见者为屎肠球菌(20/106,18.9%)。最常见感染部位为肺部感染(38/105,36.2%)及多部位感染(30/105,28.6%)。术后死亡6例(6/105,5.7%),均为感染患者。单因素分析显示术前终末期肝病模型(model for end stage liver disease,MELD)评分、术前半个月内抗生素使用、术前2个月内感染、术中红细胞输注量≥8 U、术后导尿管留置≥4 d及使用巴利昔单抗≥40 mg与感染发生有关;多元logistic回归分析显示仅术前两个月内感染(OR=5.172,95%CI:1.905~14.039,P<0.01)是肝移植术后细菌与真菌感染发生的独立危险因素,使用巴利昔单抗≥40 mg(OR=0.197,95%CI:0.051~0.762,P<0.05)的肝移植受者术后细菌与真菌感染率降低。结论:肝移植术后早期细菌与真菌感染发生率高,感染后病死率明显高于非感染患者,最常见感染部位为肺部,最多见病原体为G-杆菌。术前2个月内感染的受者术后易发生细菌与真菌感染。规范使用巴利昔单抗有助于减少肝移植术后感染的发生。
文摘Antibody induction therapy is frequently used as an adjunct to the maintenance immunosuppression in adult kidney transplant recipients. Published data support antibody induction in patients with immunologic risk to reduce the incidence of acute rejection(AR) and graft loss from rejection. However, the choice of antibody remains controversial as the clinical studies were carried out on patients of different immunologic risk and in the context of varying maintenance regimens. Antibody selection should be guided by a comprehensive assessment of immunologic risk, patient comorbidities, financial burden as well as the maintenance immunosuppressives. Lymphocyte-depleting antibody(thymoglobulin, ATGAM or alemtuzumab) is usually recommended for those with high risk of rejection, although it increases the risk of infection and malignancy. For low risk patients, interleukin-2 receptor antibody(basiliximab or daclizumab) reduces the incidence of AR without much adverse effects, making its balance favorable in mostpatients. It should also be used in the high risk patients with other medical comorbidities that preclude usage of lymphocyte-depleting antibody safely. There are many patients with very low risk, who may be induced with intravenous steroids without any antibody, as long as combined potent immunosuppressives are kept as maintenance. In these patients, benefits with antibody induction may be too small to outweigh its adverse effects and financial cost. Rituximab can be used in desensitization protocols for ABO and/or HLA incompatible transplants. There are emerging data suggesting that alemtuzumab induction be more successful than other antibody for promoting less intensive maintenance protocols, such as steroid withdrawal, tacrolimus monotherapy or lower doses of tacrolimus and mycophenolic acid. However, the long-term efficacy and safety of these unconventional strategies remains unknown.
