Yang Ji-wei, Wang Jian-ning, Men Tong-yi, Zhang Xiao-ming, Li Xian-duo, Shen Bin, Li Guang-yun, Chen Dong-dong
Department of Urology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China (mainland).
Ann Transplant. 2014 Jun 6;19:277-82. doi: 10.12659/AOT.890069.
To explore a better balance between efficacy and complications, we respectively compared the clinical outcome of low-dose and high-dose rATG induction therapy with a control group in renal transplantations from March 2009 to March 2012.
281 kidney transplant recipients were included in 3 groups. The low-dose group (n=39) received rATG 1 mg/kg on the first day and 0.5 mg/kg on the next consecutive 3 days post-transplantation. The high-dose group (n=30) received rATG 1 mg/kg for 6 days. The control group (n=212) received no induction therapy. All patients were treated with Prednisolone, Mycophenolate mofetil, cyclosporine A, or tacrolimus capsules. Acute rejection rates, renal function, CMV infection, patient survival, and the adverse effects of rATG were reviewed.
The acute rejection rate was significantly lower in the rATG group compared with the control group (low-dose 17.9% vs. control 35.4%, P=0.03, and high-dose 16.7% vs. control 35.4%, P=0.038). There was no statistically significant difference in 3-year survival and graft survival rates among the groups. Renal function early recovery was similar in the rATG and the control group. The CMV infection rate in the high-dose rATG group was higher than the low-dose rATG and the control group (p=0.037 and p=0.002, respectively). rATG induction therapy was associated with thrombocytopenia in our series, especially in the high-dose rATG group.
Low-dose rATG induction may be superior to high-dose rATG induction therapy in renal transplantation.
为了探索疗效与并发症之间更好的平衡，我们于2009年3月至2012年3月在肾移植中分别比较了低剂量和高剂量兔抗人胸腺细胞球蛋白（rATG）诱导治疗与对照组的临床结局。
281例肾移植受者被纳入3组。低剂量组（n = 39）在移植后第一天接受1 mg/kg的rATG，随后连续3天每天接受0.5 mg/kg。高剂量组（n = 30）接受1 mg/kg的rATG共6天。对照组（n = 212）未接受诱导治疗。所有患者均接受泼尼松龙、霉酚酸酯、环孢素A或他克莫司胶囊治疗。回顾了急性排斥反应率、肾功能、巨细胞病毒（CMV）感染、患者生存率以及rATG的不良反应。
与对照组相比，rATG组的急性排斥反应率显著更低（低剂量组17.9% vs. 对照组35.4%，P = 0.03；高剂量组16.7% vs. 对照组35.4%，P = 0.038）。各组间3年生存率和移植物生存率无统计学显著差异。rATG组和对照组的肾功能早期恢复情况相似。高剂量rATG组的CMV感染率高于低剂量rATG组和对照组（分别为p = 0.037和p = 0.002）。在我们的研究系列中，rATG诱导治疗与血小板减少有关，尤其是在高剂量rATG组。
在肾移植中，低剂量rATG诱导可能优于高剂量rATG诱导治疗。
