Martins L, Fonseca I, Almeida M, Henriques A C, Dias L, Sarmento A M, Cabrita A
Nephrology Department, Hospital Santo António, Porto, Portugal.
Transplant Proc. 2005 Jul-Aug;37(6):2755-8. doi: 10.1016/j.transproceed.2005.05.003.
We analyzed the impact of antithymocyte globulin (ATG) in renal transplantation. We retrospectively studied 1217 recipients performed from July 83 to December 03. ATG-Fresenius-S (ATG-F) was used for induction therapy in 492 patients (40.4%; group I) and compared with group II, 725 patients (59.6%), without antilymphocyte induction. Groups were comparable in terms of recipient gender and race distribution; time on dialysis; cause of renal disease; number of human leukocyte antigen (HLA) mismatches; donor age, gender, and creatinine; and cold ischemia time. Patients with ATG-F were younger (35.8 +/- 13.8 vs 38.9 +/- 12.5 years, P < .001), more frequently hypersensitized (10% vs 3%, P < .001), and had more second transplants (15.7% vs 5.8%, P < .001). The incidence of acute rejection episodes was lower among ATG-F patients (23.6% vs 32.1%, P = .004). Admission time and incidence of delayed graft function (DGF) were similar in the two groups. Graft survival at 1, 5, 10, and 15 years was 88.9%, 80.7%, 71.3%, and 64.9% in group I and 86.4%, 77.4%, 60.7%, and 48.4% in group II (P = .003). The difference in patient survival over the same follow-up did not reach statistical significance. Multivariate analysis showed that the risk of graft failure was higher for those who did not receive ATG-F (HR = 1.51; 95% CI, 1.14 to 2.00; P = .004). Donor age and DGF were also independent predictors of graft failure. Our results showed a better long-term graft survival among patients who received ATG-F, despite their higher immunological risk. The absence of induction with ATG-F, donor age, and DGF were independent risk factors for graft failure.
我们分析了抗胸腺细胞球蛋白（ATG）在肾移植中的影响。我们回顾性研究了1983年7月至2003年12月期间进行的1217例肾移植受者。492例患者（40.4%；第一组）使用费森尤斯ATG（ATG-F）进行诱导治疗，并与725例患者（59.6%）的第二组进行比较，第二组未进行抗淋巴细胞诱导。两组在受者性别和种族分布、透析时间、肾病病因、人类白细胞抗原（HLA）错配数、供体年龄、性别和肌酐以及冷缺血时间方面具有可比性。接受ATG-F治疗的患者更年轻（35.8±13.8岁 vs 38.9±12.5岁，P <.001），致敏频率更高（10% vs 3%，P <.001），二次移植更多（15.7% vs 5.8%，P <.001）。ATG-F治疗的患者急性排斥反应发生率较低（23.6% vs 32.1%，P =.004）。两组的住院时间和移植肾功能延迟（DGF）发生率相似。第一组1年、5年、10年和15年的移植物存活率分别为88.9%、80.7%、71.3%和64.9%，第二组分别为86.4%、77.4%、60.7%和48.4%（P =.003）。在相同随访期间患者存活率的差异未达到统计学意义。多因素分析显示，未接受ATG-F治疗的患者移植物失败风险更高（HR = 1.51；95%CI，1.14至2.00；P =.004）。供体年龄和DGF也是移植物失败的独立预测因素。我们的结果表明，尽管接受ATG-F治疗的患者免疫风险较高，但他们的长期移植物存活率更高。未使用ATG-F进行诱导、供体年龄和DGF是移植物失败的独立危险因素。
