Mehrabi A, Mood Zh A, Sadeghi M, Schmied B M, Müller S A, Welsch Th, Kuttymuratov G, Wente M N, Weitz J, Zeier M, Morath Ch, Riediger C, Schemmer P, Encke J, Büchler M W, Schmidt J
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg.
Nephrol Dial Transplant. 2007 Sep;22 Suppl 8:viii54-viii60. doi: 10.1093/ndt/gfm651.
Since the beginning of organ transplantation, graft preservation has been one of the most important concerns. Ischemia reperfusion injury (IRI), which plays an important role in the quality and function of the graft, is a major cause for increased length of hospitalization and decreased long term graft survival. Among numerous attempts which have been made to minimize graft damage associated with IRI, the use of Thymoglobulin (TG) seems to offer potential benefits. TG is a polyclonal antibody which blocks multiple antigens related to IRI, in addition to its better known T cell depleting effects. This review will focus on the use of TG in preventing IRI in kidney transplantation (KTx) and liver transplantation (LTx). Different studies in experimental and clinical transplantation have shown that TG protects renal and liver grafts from IRI. Improvement in early graft function and decreased delayed graft function (DGF) rates are some of the clinical benefits of TG. Additionally, it is used in patients with hepatorenal syndrome to support the recovery of kidney function after LTx, by allowing reduced exposure to nephrotoxic calcineurin inhibitors as well as improving liver graft function by minimizing IRI. TG can reduce acute rejection rates in kidney and liver transplant recipients, decrease the length of hospital stay, and hence reduce transplantation costs. TG can play an important role in expanding the donor pool in both KTx and LTx by improving long-term graft and patient survival rates which increases the possibility of using marginal donors. Although controversial, the development of post-transplant lymphoproliferative disorder is a potential side effect of TG. No single optimal immunosuppressive regimen has given consistent results in decreasing the graft damage following IRI; however, TG usage in KTx and LTx appears to have some benefits in reducing IRI.
自器官移植开始以来，移植物保存一直是最重要的关注点之一。缺血再灌注损伤（IRI）在移植物的质量和功能中起着重要作用，是住院时间延长和移植物长期存活率降低的主要原因。在众多旨在尽量减少与IRI相关的移植物损伤的尝试中，使用抗胸腺细胞球蛋白（TG）似乎具有潜在益处。TG是一种多克隆抗体，除了其广为人知的耗竭T细胞的作用外，还能阻断与IRI相关的多种抗原。本综述将聚焦于TG在肾移植（KTx）和肝移植（LTx）中预防IRI的应用。实验和临床移植中的不同研究表明，TG可保护肾和肝移植物免受IRI损伤。早期移植物功能的改善和延迟性移植物功能障碍（DGF）发生率的降低是TG的一些临床益处。此外，它还用于肝肾综合征患者，通过减少对肾毒性钙调神经磷酸酶抑制剂的暴露以及通过最大限度地减少IRI来改善肝移植物功能，从而支持LTx后肾功能的恢复。TG可降低肾和肝移植受者的急性排斥反应发生率，缩短住院时间，从而降低移植成本。TG可通过提高移植物和患者的长期存活率，在扩大KTx和LTx的供体库方面发挥重要作用，这增加了使用边缘供体的可能性。尽管存在争议，但移植后淋巴细胞增生性疾病的发生是TG的一种潜在副作用。在减少IRI后的移植物损伤方面，没有单一的最佳免疫抑制方案能给出一致的结果；然而，在KTx和LTx中使用TG似乎在减少IRI方面有一些益处。
