Department of Pharmacy Services, Hospital of University of Pennsylvania, Philadelphia, PA 19104-4322, USA.
Transplantation. 2012 Sep 15;94(5):506-12. doi: 10.1097/TP.0b013e31825c58c0.
In an effort to reduce length of stay (LOS) in kidney transplant recipients otherwise ready for discharge, we developed a protocol to extend rabbit antithymocyte globulin (rATG) induction therapy into the outpatient setting through peripheral dose administration.
A retrospective review of outpatient rATG group (n=185) that received the first two rATG doses inpatient and subsequent doses outpatient was used, compared with concurrently transplanted patients who received all doses of rATG as an inpatient (n=99).
The outpatient group received more rATG (cumulative mg/kg induction) than the inpatient-only group (median [range], 4.8 mg/kg [3.2-10.0] vs. 4.4 mg/kg [2.8-8.6]; P<0.01). Outpatient usage avoided 246 hospital days that would have been required had rATG been administered in the inpatient setting. The incidences of perioperative leukopenia and thrombocytopenia were lower in the outpatient rATG group versus inpatient-only group (5% vs. 21%, P<0.01, and 2% vs. 9%, P<0.01, respectively) but were similar by 3 months. The outpatient rATG group experienced shorter hospitalization LOS compared with the inpatient-only group (median LOS [range], 4 [2-11] vs. 5 [3-20] days; P<0.01) and lower 30-day readmission rates (30% vs. 42%, P=0.03). At 6 months, there were no differences in incidences of biopsy-proven rejection episodes.
When implemented selectively among less complicated kidney transplant recipients, delayed extension of rATG into the outpatient setting was associated with LOS reduction and attendant cost saving without either increasing readmission rate or compromising short-term safety and efficacy.
为了减少准备出院的肾移植受者的住院时间（LOS），我们开发了一种方案，通过外周剂量给药将兔抗胸腺细胞球蛋白（rATG）诱导疗法扩展到门诊环境中。
回顾性分析了门诊 rATG 组（n=185），他们在住院期间接受了前两剂 rATG，然后在门诊接受后续剂量，同时与接受所有 rATG 剂量作为住院患者的移植患者进行比较（n=99）。
门诊组接受的 rATG 剂量多于仅住院组（中位数[范围]，4.8mg/kg[3.2-10.0] vs. 4.4mg/kg[2.8-8.6]；P<0.01）。门诊使用避免了如果 rATG 在住院环境中给药则需要的 246 个住院日。门诊 rATG 组与仅住院组相比，围手术期白细胞减少和血小板减少的发生率较低（5% vs. 21%，P<0.01，和 2% vs. 9%，P<0.01），但在 3 个月时相似。门诊 rATG 组的住院 LOS 短于仅住院组（中位数 LOS[范围]，4[2-11] vs. 5[3-20]天；P<0.01），30 天再入院率较低（30% vs. 42%，P=0.03）。6 个月时，活检证实排斥反应的发生率没有差异。
在较简单的肾移植受者中选择性实施时，将 rATG 延迟扩展到门诊环境中与 LOS 减少和相关成本节约相关，而不会增加再入院率或损害短期安全性和疗效。
