Wang Dong, Wu Wei-zhen, Yang Shun-liang, Chen Jin-hua, Tan Jian-ming
Department of Urology, Fuzhou General Hospital of PLA, Fuzhou 350025, China.
Chin Med J (Engl). 2006 Oct 20;119(20):1683-8.
Immunological sensitization remains a major problem following renal transplantation. There is no consensus for the management of sensitized renal allograft recipients. The patients become tethered to dialysis while waiting for compatible donors. This study was designed to evaluate the efficacy and safety of preoperative single-bolus high-dose antithymocyte globulin (ATG) as induction therapy in sensitized renal transplant recipients.
A total of 56 patients were divided into two groups according to the level of panel reactive antibody (PRA): non-sensitized group (PRA < 10%, n = 30) and sensitized group (PRA > or = 10%, n = 26). The characteristics of the recipients and donors were comparable between the two groups. Mycophenolate mofetil (MMF, 1 g) or ATG (iv. 9 mg/kg) were given preoperatively in the two groups as induction therapy. After the transplantation, the patients were treated with standard triple therapy regimen consisting of tacrolimus (FK-506) or cyclosporine A, MMF, and prednisolone. Acute rejection (AR) and infection episodes were recorded and renal function was monitored during a 12-month follow-up. Chi(2) test and t test were used to analyze the data.
During the follow-up, 6 patients (20.0%) suffered AR episodes in the non-sensitized group and 4 (15.4%) in the sensitized group (P = 0.737); 8 patients (26.7%) experienced 11 infection episodes (average, 1.4 episodes per infected patient) in the non-sensitized group, and 6 (23.1%) experienced 10 infection episodes (average, 1.7 episodes per infected patient) in the sensitized group (P = 0.757, 0.890). The safety of the drugs, which was assessed by the occurrence of side effects, was comparable between the two groups. The hospital stay was 13 - 25 days (mean, 16.7 +/- 3.3) in the non-sensitized group and 14 - 29 days (mean, 16.2 +/- 3.1) in the sensitized group, respectively (P = 0.563). No delayed graft function (DGF) was observed in all the patients. Both the 12-month actuarial patient and graft survival rates were 100% in the two groups.
Preoperative single-bolus high-dose ATG is an effective and safe induction therapy yielding acceptable acute rejection rate in sensitized renal transplant recipients.
肾移植后免疫致敏仍然是一个主要问题。对于致敏肾移植受者的管理尚无共识。患者在等待合适供体期间只能依赖透析。本研究旨在评估术前单次大剂量抗胸腺细胞球蛋白（ATG）作为致敏肾移植受者诱导治疗的有效性和安全性。
根据群体反应性抗体（PRA）水平将56例患者分为两组：非致敏组（PRA<10%，n = 30）和致敏组（PRA≥10%，n = 26）。两组受者和供者的特征具有可比性。两组术前分别给予霉酚酸酯（MMF，1g）或ATG（静脉注射9mg/kg）作为诱导治疗。移植后，患者接受由他克莫司（FK - 506）或环孢素A、MMF和泼尼松龙组成的标准三联治疗方案。记录急性排斥反应（AR）和感染事件，并在12个月的随访期间监测肾功能。采用卡方检验和t检验分析数据。
随访期间，非致敏组6例患者（20.0%）发生AR事件，致敏组4例（15.4%）（P = 0.737）；非致敏组8例患者（26.7%）发生11次感染事件（平均每例感染患者1.4次），致敏组6例（23.1%）发生10次感染事件（平均每例感染患者1.7次）（P = 0.757，0.890）。通过副作用发生情况评估的药物安全性在两组间具有可比性。非致敏组住院时间为13 - 25天（平均，16.7±3.3），致敏组为14 - 29天（平均，16.2±3.1）（P = 0.563）。所有患者均未观察到移植肾功能延迟恢复（DGF）。两组12个月的患者和移植物实际生存率均为100%。
术前单次大剂量ATG是一种有效且安全的诱导治疗方法，在致敏肾移植受者中可产生可接受的急性排斥反应率。
