Kato T, Selvaggi G, Panagiotis T, Hernandez E, McLaughlin G, Moon J, Nishida S, Levi D, Thompson J, Halliday N, Ruiz P, Tzakis A.
外科，迈阿密大学，肝脏和胃肠移植，迈阿密，弗洛里达州33136，美国

自从2001年本研究组将Campath 1H (C1H)成功应用于成人肝移植受体后，我们便开始将其应用到儿童患者身上。

患者和方法：我们对10名儿童使用了C1H诱导剂，分别是自身免疫性肝炎患者（AIH）（ 6例），原发性硬化性胆管炎患者（PSC）（ 1例），胆道闭锁患者（ 1例），肝糖储积症患者（ 1例）和威尔逊病患者（1例）。其中8例为首次移植，2例为肝脏再次移植，年龄为5至17岁。第0、4、70天C1H的注射剂量为0.3mg/kg，他克莫司(Tacrolimus)水平保持在5至10 ng/ml。除2人在移植时使用皮质激素疗法外，没有患者使用类固醇维持术后。医生给这些患者开了低剂量的类固醇。C1H受体的平均随访时间为679天（随访时间范围为115—1143天）。

结果：大部分患者术后情况稳定，仅一例肝脏再次移植的患者需长期住院（40天）才能康复。患者的平均住院时间为12天（范围为7—40天）。C1H组的10名患者均存活，移植肝功能稳定，且没有一例发生机会性感染。我们把6例接受C1H的AIH患者与10例接受常规免疫治疗（他克莫司+类固醇）的患者进行了对照比较。应用C1H治疗的患者无排斥生存明显更高。

结论：根据我们的初步经验，C1H诱导剂在小儿肝移植受体中的耐受性良好。尽管AIH受体为低水平免疫，但此类患者的无排斥生存相对更长。

PMID: 17175346 [PubMed - indexed for MEDLINE]

Transplant Proc. 2006 Dec;38(10):3609-11.

Kato T, Selvaggi G, Panagiotis T, Hernandez E, McLaughlin G, Moon J, Nishida S, Levi D, Thompson J, Halliday N, Ruiz P, Tzakis A.
Department of Surgery, University of Miami, Liver and GI Transplant, Miami, Florida 33136, USA.

　　Since Campath 1H (C1H) has been successfully used in adult liver transplant recipients since 2001 in our program, we started to use it in children.
PATIENTS AND METHODS: C1H induction was employed in 10 children with autoimmune hepatitis (AIH) (n = 6), primary sclerosing cholangitis (PSC) (n = 1), biliary atresia (n = 1), glycogen storage disease (n = 1), and Wilson's disease. Eight were primary transplants, and two retransplants. Patients ages ranged from 5 to 17 years. C1H was administered at a dose of 0.3 mg/kg on days 0, 4, and 7. Tacrolimus level was maintained at 5 to 10 ng/mL. No patient received maintenance steroids posttransplantation except two who were on steroid therapy at the time transplant. They were prescribed small doses of maintenance steroids. Median follow-up of C1H recipients was 679 days (range 115-1143).
RESULTS: Postoperative courses were mostly uneventful except for one retransplant recipient who required prolonged hospitalization (40 days) for rehabilitation. Median hospital stay was 12 days (range 7-40 days). All 10 patients in the C1H group are currently alive and well with stable graft function. No opportunistic infection was observed in these patients to date. We compared six patients with AIH who received C1H to the historic control of 10 recipients with AIH who received conventional immunosuppression (tacrolimus + steroid). The patients treated with C1H showed significantly prolonged rejection-free survival.
CONCLUSION: In our preliminary experience, C1H induction was well tolerated in pediatric liver recipients. Rejections-free survival was prolonged among recipients with AIH despite a low level of maintenance immunosuppression.
PMID: 17175346 [PubMed - indexed for MEDLINE]

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