Индукционная иммуносупрессия при трансплантации почки: Тимоглобулин® (обзор литературы)
Аннотация
Кроличий антитимоцитарный иммуноглобулин – тимоглобулин – впервые был получен более 25 лет назад и в настоящее время является наиболее широко используемым антилимфоцитарным иммуноглобулином в трансплантации паренхиматозных органов. Тимоглобулин взаимодействует с широким диапазоном поверхностных антигенов Т-лимфоцитов, натуральных киллеров, В-лимфоцитов и плазматических клеток, а также с молекулами адгезии и рецепторами хемокинов, что приводит к длительной лимфопении. Рандомизированные исследования показали эффективность тимоглобулина в отношении профилактики острого отторжения трансплантата при пересадке почки. Экспериментальные и клинические исследования дают основание предполагать, что применение тимоглобулина может меньшить явления ишемически-реперфузионного повреждения (ИРП), снижая, таким образом, частоту случаев отсроченной функции трансплантата (ОФТ). Также данные исследования доказали преимущество тимоглобулина, связанное с минимизацией иммуносупрессии: отменой кортикостероидов и ингибиторов кальциневрина (CNI) и улучшением эффективности лечения в отношении сердечно-сосудистой системы и почек. Оптимальная кумулятивная доза тимоглобулина в режиме индукционной терапии составляет 6–7,5 мг/кг при условии мониторинга показателей лабораторных исследований крови.
На данный момент индукция тимоглобулином показана пациентам из группы высокого иммунологического риска (с повышенным риском ОФТ), а также в целях сохранения эффективности иммуносупрессии у реципиентов из группы стандартного риска, получающих терапию с использованием минимальных доз стероидов или ингибиторов CNI, либо же в случае их полной отмены.
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Рецензия
Для цитирования:
Пинчук А.В. Индукционная иммуносупрессия при трансплантации почки: Тимоглобулин® (обзор литературы). Трансплантология. 2014;(2):31-43.
For citation:
Pinchuk A.V. Induction immunosuppression in kidney transplantation: Thymoglobulin® (a literature review). Transplantologiya. The Russian Journal of Transplantation. 2014;(2):31-43.
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