肾移植中单剂 rATG 诱导：肾功能更佳且血糖调节更好，低镁血症更少。

Single-dose rATG induction at renal transplantation: superior renal function and glucoregulation with less hypomagnesemia.

机构信息

Departments of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA.

出版信息

Clin Transplant. 2012 Jan-Feb;26(1):123-32. doi: 10.1111/j.1399-0012.2011.01425.x. Epub 2011 Mar 14.

DOI:10.1111/j.1399-0012.2011.01425.x

PMID:21401720

Abstract

BACKGROUND

Rabbit anti-thymocyte globulin (rATG) induction reduces reperfusion injury and improves renal function in kidney recipients by means of properties unrelated to T-cell lysis. Here, we analyze intensive rATG induction (single dose, rATG(S) , vs. divided dose, rATG(D) ) for improved renal function and protection against hyperglycemia.

METHODS

Patients without diabetes (n = 98 of 180) in a prospective randomized trial of intensive rATG induction were followed for six months for the major secondary composite end point of impaired glucose regulation (hyperglycemia and new-onset diabetes after transplantation, NODAT). Prospectively collected data included fasting blood glucose and HbA(1c). Serum Mg(++) was routinely collected and retrospectively analyzed.

RESULTS

Induction with rATG(S) produced less impaired glucose regulation (p = 0.05), delayed NODAT development (p = 0.02), less hyperglycemia (p = 0.02), better renal function (p = 0.04), and less hypomagnesemia (p = 0.02), a factor associated with a lower incidence of NODAT. Generalized linear modeling confirmed that rATG(S) protects against a synergistic interaction between tacrolimus and sirolimus that otherwise increased hypomagnesemia (p = 0.008) and hyperglycemia (p = 0.03).

CONCLUSIONS

rATG(S) initiated before renal reperfusion improved early renal function and reduced impaired glucose regulation, an injury by diabetogenic maintenance agents (tacrolimus and sirolimus).

摘要

背景

兔抗胸腺细胞球蛋白（rATG）诱导通过与 T 细胞溶解无关的特性减少肾移植受者的再灌注损伤并改善肾功能。在此，我们分析了强化 rATG 诱导（单剂量 rATG(S)，与分剂量 rATG(D)）对改善肾功能和预防高血糖的作用。

方法

在一项强化 rATG 诱导的前瞻性随机试验中，98 例无糖尿病的患者（180 例中的 98 例）随访 6 个月，以评估主要次要复合终点（葡萄糖调节受损，包括高血糖和移植后新发糖尿病，NODAT）。前瞻性收集的资料包括空腹血糖和 HbA(1c)。常规收集血清 Mg(++)并进行回顾性分析。

结果

rATG(S) 诱导引起的葡萄糖调节受损较少（p = 0.05），NODAT 发生延迟（p = 0.02），高血糖较少（p = 0.02），肾功能较好（p = 0.04），低镁血症较少（p = 0.02），低镁血症是 NODAT 发生率较低的一个相关因素。广义线性模型证实，rATG(S) 可防止他克莫司和西罗莫司之间的协同相互作用，否则会增加低镁血症（p = 0.008）和高血糖（p = 0.03）。