CORESOT__培训课件.pptVIP

移植14天后开始使用CsA的患者被判定为肾功能延迟恢复。所有患者中，肾功能延迟恢复患者的急性排斥风险显著更高，但使用即复宁后，肾功能早期恢复患者与延迟恢复患者的急性排斥反应率却没有差异且概率很低，得出即复宁降低了肾功能恢复延迟患者的急性排斥反应发生率。 CsA延迟使用患者为肾功能延迟恢复患者，即复宁联合西罗莫司的使用与其没有关系。 肌酐水平下降后使用CsA 原文研究结论：“在高危即复宁组中，患者的肾功能恢复显著比巴利昔单抗组快，疗效持久稳定” 结论：A strategy combining sirolimus with thymoglobulin for high-risk recipients leads to prompt recovery of renal function with a low risk of acute rejection episodes. * * * * * * * * 即复宁较OKT3耐受性更优 不良事件 (%) 即复宁组 (n=31) OKT3组 (n=29) P值 发热 6 52 0.001 白细胞血小板减少 22 17 - 巨细胞病毒感染 39 45 - 疱疹病毒感染 10 7 - 严重细菌感染 6 10 - 泌尿道感染 4 7 - 单克隆γ病 6 10 - 实体肿瘤 0 7 - Mariat C, et al. Transpl Int 1998;11(3):231-236. 低剂量即复宁和OKT3均可有效逆转肾移植后的耐激素性急性排斥反应，但即复宁耐受性更佳，免疫抑制作用更为有效持久，且剂量减少也未降低其疗效 结论 谢 谢 Steps in T-Cell–Mediated Rejection. Antigen-presenting cells of host or donor origin migrate to T-cell areas of secondary lymphoid organs. These T cells ordinarily circulate between lymphoid tissues, regulated by chemokine and sphingosine-1-phosphate (S-1-P) receptors. APCs present donor antigen to naive and central memory T cells. Some presentation of antigen by donor cells in the graft cannot be excluded (e.g., endothelial cells that activate antigen-experienced T cells). T cells are activated and undergo clonal expansion and differentiation to express effector functions. Antigen triggers T-cell receptors (TCRs) (signal 1) and synapse formation. CD80 (B7-1) and CD86 (B7-2) on the APC engage CD28 on the T cell to provide signal 2. These signals activate three signal-transduction pathways — the calcium–calcineurin pathway, the mitogen-activated protein (MAP) kinase pathway, and the protein kinase C–nuclear factork B (NFk B) pathway — which activate transcription factors nuclear factor of activated T cells (NFAT), activating protein 1 (AP-1), and NFk B, respectively. The result is expression of CD154 (which further activates APCs), interleukin-2 receptor a chain (CD25), and interleukin-2. Receptors for a number of cytokines (interleukin-2, 4, 7, 15, and 21) share the common g chain, whi