Miller James T, Collins Curtis D, Stuckey Linda J, Luan Fu L, Englesbe Michael J, Magee John C, Park Jeong M
Department of Pharmacy Services, Sinai-Grace Hospital, Detroit, MI 48109-5008, USA.
Pharmacotherapy. 2009 Oct;29(10):1166-74. doi: 10.1592/phco.29.10.1166.
To evaluate the efficacy, safety, and costs of rabbit antithymocyte globulin (TMG) induction in patients who received kidney transplants from living unrelated donors.
Retrospective cohort study.
Large academic medical center.
Eighty-seven patients who received kidney transplants from living unrelated donors: 40 of the recipients underwent transplantation between January 1, 2003, and December 31, 2004, and did not receive TMG induction (no induction group); 47 underwent transplantation between January 1, 2005, and June 30, 2006, and received TMG induction (induction group). All patients received cyclosporine-based immunosuppression.
Biopsy-proven acute rejection, posttransplantation complications, and inpatient hospital costs for the first 12 months after transplantation were compared between groups using standard univariate statistical analyses. Induction significantly decreased the occurrence of biopsy-proven acute rejection versus no induction (2% vs 48%, p<0.001). Fifty percent of rejection episodes in the no induction group required hospitalization, and 46% of rejection episodes required TMG treatment. Slightly elevated initial costs associated with TMG induction were offset by lower costs related to rejection treatment. Total inpatient costs for the 12 months after transplantation were comparable between the groups (no induction $66,038 vs induction $74,183, p>0.05). For the no induction versus induction groups, no significant differences in cytomegalovirus disease (5% vs 6%), malignancy (3% vs 2%), graft failures (5% vs 6%), mortality (5% vs 4%), and serum creatinine concentrations (mean +/- SD 1.4 +/- 0.3 vs 1.5 +/- 0.3 mg/dl) were observed at 12 months (p>0.05 for all comparisons).
Five-day TMG induction effectively reduced the 1-year acute rejection rate without significantly increasing total inpatient costs or posttransplantation complications among recipients of kidney transplants from living unrelated donors.
评估兔抗胸腺细胞球蛋白（TMG）诱导治疗对接受来自非亲属活体供肾移植患者的疗效、安全性及成本的影响。
回顾性队列研究。
大型学术医疗中心。
87例接受非亲属活体供肾移植的患者：40例受者于2003年1月1日至2004年12月31日期间接受移植，未接受TMG诱导治疗（未诱导组）；47例于2005年1月1日至2006年6月30日期间接受移植，并接受TMG诱导治疗（诱导组）。所有患者均接受以环孢素为基础的免疫抑制治疗。
采用标准单变量统计分析方法，比较两组患者移植后12个月内经活检证实的急性排斥反应、移植后并发症及住院费用。与未诱导治疗相比，诱导治疗显著降低了经活检证实的急性排斥反应发生率（2%对48%，p<0.001）。未诱导组50%的排斥反应发作需要住院治疗，46%的排斥反应发作需要TMG治疗。TMG诱导治疗初期成本略有升高，但因排斥反应治疗成本降低而得到抵消。两组移植后12个月的总住院费用相当（未诱导组66,038美元对诱导组74,183美元，p>0.05）。未诱导组与诱导组在12个月时，巨细胞病毒疾病（5%对6%）、恶性肿瘤（3%对2%）、移植失败（5%对6%）、死亡率（5%对4%）及血清肌酐浓度（均值±标准差1.4±0.3对1.5±0.3mg/dl）方面均未观察到显著差异（所有比较p>0.05）。
为期5天的TMG诱导治疗可有效降低1年急性排斥反应发生率，且不会显著增加接受非亲属活体供肾移植受者的总住院费用或移植后并发症。
