成人肾移植中胸腺球蛋白与抗胸腺细胞球蛋白诱导治疗的五年随访
Five-year follow up of thymoglobulin versus ATGAM induction in adult renal transplantation.
作者信息
Hardinger Karen L, Schnitzler Mark A, Miller Brent, Lowell Jeffrey A, Shenoy Surendra, Koch Matthew J, Enkvetchakul Decha, Ceriotti Connie, Brennan Daniel C
机构信息
Department of Pharmacy, Washington University School of Medicine, St. Louis, MO, USA.
出版信息
Transplantation. 2004 Jul 15;78(1):136-41. doi: 10.1097/01.tp.0000132329.67611.3f.
BACKGROUND
One-year results of a randomized, double-blinded trial of Thymoglobulin versus Atgam for induction therapy in renal transplantation revealed that Thymoglobulin was associated with higher event-free survival (94% vs. 63%), less acute rejection (4% vs. 25%), and better graft survival. This article compares the safety and efficacy of Thymoglobulin versus Atgam induction through 5 years.
METHODS
Review and analysis of clinic records and electronic databases.
RESULTS
At 5 years, event-free survival (73% vs. 33%, P<0.001), graft survival (77% vs. 55%, P=0.047), and freedom from rejection (92% vs. 66%, P=0.007) were higher with Thymoglobulin versus Atgam. No additional cytomegalovirus (CMV) disease occurred after the first year with Thymoglobulin or Atgam (13% vs. 33%, P=0.056). There were two cases of posttransplant lymphoproliferative disorder (PTLD) with the Atgam arm and none with Thymoglobulin. Thymoglobulin was associated with profound lymphopenia at 2 years after transplantation.
CONCLUSIONS
Thymoglobulin was associated with higher event-free survival, graft survival, and freedom from rejection without increased PTLD or CMV disease at 5 years compared with Atgam. The prolonged and profound lymphopenia may contribute to the long-term results associated with Thymoglobulin.
背景
一项关于在肾移植诱导治疗中使用兔抗人胸腺细胞球蛋白（Thymoglobulin）与抗胸腺细胞球蛋白（Atgam）的随机双盲试验的一年结果显示，兔抗人胸腺细胞球蛋白与更高的无事件生存率（94%对63%）、更少的急性排斥反应（4%对25%）以及更好的移植物存活率相关。本文比较了兔抗人胸腺细胞球蛋白与抗胸腺细胞球蛋白诱导治疗5年的安全性和疗效。
方法
回顾和分析临床记录及电子数据库。
结果
在5年时，兔抗人胸腺细胞球蛋白组的无事件生存率（73%对33%，P<0.001）、移植物存活率（77%对55%，P=0.047）和无排斥反应率（92%对66%，P=0.007）均高于抗胸腺细胞球蛋白组。在使用兔抗人胸腺细胞球蛋白或抗胸腺细胞球蛋白的第一年之后，未再发生额外的巨细胞病毒（CMV）疾病（13%对33%，P=0.056）。抗胸腺细胞球蛋白组有2例移植后淋巴细胞增生性疾病（PTLD），而兔抗人胸腺细胞球蛋白组无。兔抗人胸腺细胞球蛋白与移植后2年时的严重淋巴细胞减少有关。
结论
与抗胸腺细胞球蛋白相比，兔抗人胸腺细胞球蛋白在5年时与更高的无事件生存率、移植物存活率和无排斥反应率相关，且未增加PTLD或CMV疾病的发生率。长期且严重的淋巴细胞减少可能促成了与兔抗人胸腺细胞球蛋白相关的长期结果。
Zotero 插件