Soliman Thomas, Hetz Hubert, Burghuber Christoph, Györi Georg, Silberhumer Gerd, Steininger Rudolf, Mühlbacher Ferdinand, Berlakovich Gabriela A
Division of Transplantation, Department of Surgery, Medical University Vienna, Austria.
Liver Transpl. 2007 Jul;13(7):1039-44. doi: 10.1002/lt.21185.
The appropriate time point for starting immunosuppressive treatment with calcineurin inhibitors after orthotopic liver transplantation (OLT) has been a subject of debate. The aim of the study was to analyze the effects of anti-thymocyte globulin (ATG) induction therapy on rejection, renal function, infection, tumor rate, and survival. We retrospectively analyzed 391 patients after OLT who had either received calcineurin inhibitors immediately after OLT (n = 129) or after an initial short-term Thymoglobulin induction therapy (n = 262). The 1-year acute rejection rate was 14.5% vs. 31.8% in favor of ATG (P = 0.0008). Rejection grades and the need for treatment also differed significantly (7.3% vs. 23.3%; P = 0.001). Serum creatinine at transplantation was similar in both groups (1.14 mg/dL vs.1.18 mg/dL; P = NS). Postoperative hemofiltration was less frequently seen after induction therapy (P < 0.05). Reduced renal function at 1 year was commonly observed, but serum creatinine (1.26 mg/dL vs. 1.37mg/dL; P = 0.015) and glomerular filtration rate (81 mL/min vs. 75 mL/min; P = 0.02) were far better in the ATG group. Undesired side effects occurred at a similar rate in both groups. Five-year patient survival was also similar in the 2 groups (70.1% and 74.3%; P > 0.05). Short-term ATG induction therapy with delayed administration of calcineurin inhibitors led to a more favorable rejection rate and an improved clinical course in case of a rejection episode. It has beneficial effects on renal function immediately after OLT as well as later, and no additional harmful effects.
原位肝移植（OLT）后开始使用钙调神经磷酸酶抑制剂进行免疫抑制治疗的合适时间点一直是一个有争议的话题。本研究的目的是分析抗胸腺细胞球蛋白（ATG）诱导治疗对排斥反应、肾功能、感染、肿瘤发生率和生存率的影响。我们回顾性分析了391例OLT术后患者，这些患者在OLT术后立即接受了钙调神经磷酸酶抑制剂治疗（n = 129）或接受了初始短期的兔抗人胸腺细胞免疫球蛋白诱导治疗（n = 262）。1年急性排斥反应率分别为14.5%和31.8%，ATG组更有利（P = 0.0008）。排斥反应分级和治疗需求也有显著差异（7.3%对23.3%；P = 0.001）。两组移植时的血清肌酐相似（1.14 mg/dL对1.18 mg/dL；P = 无统计学意义）。诱导治疗后术后血液滤过较少见（P < 0.05）。1年时肾功能下降较为常见，但ATG组的血清肌酐（1.26 mg/dL对1.37mg/dL；P = 0.015）和肾小球滤过率（81 mL/min对75 mL/min；P = 0.02）要好得多。两组不良副作用发生率相似。两组患者5年生存率也相似（70.1%和74.3%；P > 0.05）。短期ATG诱导治疗并延迟给予钙调神经磷酸酶抑制剂导致更有利的排斥反应率，并且在发生排斥反应时临床病程改善。它对OLT术后即刻及后期的肾功能均有有益作用，且无额外有害影响。
