目的： Interleukin-2接受器拮抗劑(IL-2RAs)，包含basiliximab及daclizumab，為預防腎移植術後急性排斥而做為前導治療(induction therapy)的藥物。本研究目的為探討本院腎移植病人使用basiliximab與daclizumab之臨床效益及其差異。
方法： 研究採回溯調查方式，對象為1998年2月至2008年10月期間在本院接受腎移植病人，並持續追蹤其治療至2009年12月。
結果： 共154位腎移植病人納入研究，其中使用basiliximab與daclizumab者各44位，未使用者66位。術後第1年此三組之急性排斥發生率分別為20.5%，13.6%及28.8%。術後第1年此三組之平均血中肌酸酐分別為1.5 ± 0.4 mg/dL；1.5 ± 0.5 mg/dL與1.5 ± 0.7 mg/dL (p > 0.05)。病人死亡數，使用IL-2RA組有4位（皆在daclizumab組），未使用組5位。因感染住院，使用IL-2RA組有33位（basiliximab組20位及daclizumab組13位），而未使用組有32位。術後第1年，病人存活率在使用IL-2RA組為98.5%（basiliximab組100%，daclizumab組為96.9%），而未使用組為100%。術後第1年移植腎的存活率，使用IL-2RA組為97.7%（basiliximab組及daclizumab組皆為97.7%），而未使用組為98.5%；各組間均無統計上之顯著差異。
結論： 使用basiliximab及daclizumab各2個劑量作為前導治療，在術後第1年無論是急性排斥預防、移植病人及移植腎存活率，並未明顯優於未使用者。因此使用IL-2RA做為腎移植之前導治療，似乎未具顯著性之臨床效益。
Background and Objective: Interleukin-2 receptor antagonists (IL-2RAs), including basiliximab and daclizumab, are commonly used as induction therapy in renal transplantation. The effectiveness was evaluated in our renal transplantation recipients.
Methods: Renal transplant recipients who had their operation performed in our hospital from Feb. 1998 through Oct. 2008 were enrolled and followed up till Dec. 2009 for this retrospective study. These patients were stratified according to the use of IL-2RA, both basiliximab and daclizumab or induction-free. First year acute rejection rate, patient and graft survival rate, and infection types were analyzed.
Results: A total of 154 patients including basiliximab (n = 44), daclizumab (n = 44) and induction-free (n = 66) were recruited. Acute rejection at first year was experienced in 20.5%, 13.6% and 28.8%, respectively. At 12 months, serum creatinine was 1.5 ± 0.4 mg/dL with basiliximab, 1.5 ± 0.5 mg/dL with daclizumab, and 1.5 ± 0.7 mg/dL with induction-free recipients (p > 0.05). Patient mortality occurred in 4 daclizumab and 5 induction-free cases. Major infection occurred in 33 IL-2RA patients (20 basiliximab and 13 daclizumab) and 32 induction-free patients. One year patient survival rate was 98.5% in IL-2RA group (100% basiliximab and 96.9% daclizumab) and 100% in induction-free group. One year graft survival rate was 97.7% in IL-2RA group (both basiliximab and daclizumab were 97.7%) and 98.5% in induction-free group. There were no significant differences among the groups.
Conclusion: Two doses regimen of induction with IL-2RA was no better than induction-free group in terms of acute rejection prevention, patient and graft survival. IL-2RA induction does not appear to be effectiveness.
