Department of Pharmacy Department of Surgery, The Methodist Hospital, Houston, TX, USA.
Clin Transplant. 2011 May-Jun;25(3):E250-6. doi: 10.1111/j.1399-0012.2010.01393.x. Epub 2011 Jan 13.
Antithymocyte globulin (rATG) is a commonly used induction agent in renal transplantation; however, data in older kidney recipients are limited.
We reviewed charts of 301 deceased donor renal transplants who received a protocol consisting of 3-7 doses of rATG and triple maintenance therapy. Outcomes of patients >60 yr of age (n = 45) were compared to those aged 18-59 yr (n = 256).
Older recipients had more diabetics, were more likely to receive expanded criteria donor kidneys (p < 0.01), and over 30% were sensitized. Recipients >60 received less cumulative rATG (4.6 vs. 5.1 mg/kg; p < 0.01). Three-yr acute rejection was lower in the >60 group (2% vs. 16%, p < 0.01) although glomerular filtration rates were similar between groups. Actuarial graft survival was similar; however, patient survival in the >60 group at three yr was lower (80% vs. 95%; p = 0.02). Specifically, patients >60 with delayed graft function and rATG cumulative dosing >6 mg/kg had a survival of <50% by two yr.
Recipients over 60 yr receiving rATG induction have acceptable renal function and a low risk of rejection; however, reduced survival was noted among those receiving >6 mg/kg. These data suggest that when used, lower cumulative dosages of rATG are preferable in the older recipient.
抗胸腺细胞球蛋白(rATG)是肾移植中常用的诱导剂;然而，在老年肾移植受者中的数据有限。
我们回顾了 301 例接受包含 3-7 剂 rATG 和三联维持治疗方案的已故供肾移植患者的病历。将年龄>60 岁的患者(n=45)的结果与 18-59 岁的患者(n=256)进行比较。
老年受者中糖尿病患者更多，更有可能接受扩大标准供肾(p<0.01)，且超过 30%的患者致敏。>60 岁的受者接受的 rATG 累积剂量较少(4.6 与 5.1 mg/kg; p<0.01)。>60 岁组的 3 年急性排斥反应较低(2%与 16%，p<0.01)，尽管两组的肾小球滤过率相似。两组的累积生存率相似;然而，>60 岁组的患者在 3 年时的生存率较低(80%与 95%，p=0.02)。具体来说，>60 岁且伴有延迟移植物功能和 rATG 累积剂量>6 mg/kg 的患者在两年时的生存率<50%。
接受 rATG 诱导的>60 岁受者的肾功能可接受，排斥反应风险低;然而，>6 mg/kg 的受者的生存率降低。这些数据表明，在老年受者中，rATG 的累积剂量较低时更可取。
