Sancho Calabuig A, Gavela Martínez E, Kanter Berga J, Beltrán Calatán S, Avila Bernabeu A I, Pallardó Mateu L M
Hospital Universitario Dr Peset, Valencia, Spain.
Hospital Universitario Dr Peset, Valencia, Spain.
Transplant Proc. 2015 Jan-Feb;47(1):50-3. doi: 10.1016/j.transproceed.2014.11.018.
Induction treatment has been recommended as part of the initial immunosuppressive regimen in kidney transplantation, and antithymocyte globulin is one of the drugs used for it, but at usual dosage it has been related to an increase of infectious and neoplastic complications. Our aim was to analyze the safety and efficacy of induction treatment with low doses of antithymocyte globulin, compared to basiliximab.
In this retrospective cohort study of 321 kidney transplant patients with a minimum follow-up of 2 years, 162 were treated with low doses of antithymocyte globulin (1.25 mg/kg, every other day) and 159 with basiliximab. Mean follow-up was 76.6 ± 37.51 months (range, 24-187 mo) and was similar for the 2 groups.
Mean number of antithymocyte globulin doses was 1.89 ± 0.32 mg/kg (range, 1-3). The globulin group received a higher proportion of kidneys from donors >70 years old (25.3% vs 13.8%; P = .010) and donors with higher creatinine levels (1.01 ± 0.62 vs 0.86 ± 0.28 mg/dL; P = .006). The basiliximab group presented a higher incidence of acute rejection (22.1% vs 9.1%; P = .010). Cytomegalovirus disease was more frequent in the globulin group (18.6% vs 8.1%; P = .011) without an increase of infectious hospitalizations. Graft (P = .214) and patient (P = .533) survivals were similar.
Induction with low doses of antithymocyte globulin resulted in a lower incidence of acute rejection with graft and patient survivals similar to that obtained with basiliximab induction, in spite of a worse donor profile. CMV disease was more frequent with antithymocyte globulin, without an increase of infectious hospitalizations or cancer development, in long-term follow-up.
诱导治疗已被推荐作为肾移植初始免疫抑制方案的一部分，抗胸腺细胞球蛋白是用于该治疗的药物之一，但常用剂量与感染和肿瘤并发症的增加有关。我们的目的是分析与巴利昔单抗相比，低剂量抗胸腺细胞球蛋白诱导治疗的安全性和有效性。
在这项对321例肾移植患者进行的回顾性队列研究中，患者至少随访2年，162例接受低剂量抗胸腺细胞球蛋白治疗（1.25mg/kg，隔日一次），159例接受巴利昔单抗治疗。平均随访时间为76.6±37.51个月（范围24 - 187个月），两组相似。
抗胸腺细胞球蛋白的平均剂量为1.89±0.32mg/kg（范围1 - 3）。球蛋白组接受来自年龄>70岁供体的肾脏比例更高（25.3%对13.8%；P = 0.010），且接受肌酐水平更高供体的肾脏比例也更高（1.01±0.62对0.86±0.28mg/dL；P = 0.006）。巴利昔单抗组急性排斥反应的发生率更高（22.1%对9.1%；P = 0.010）。巨细胞病毒病在球蛋白组更常见（18.6%对8.1%；P = 0.011），但感染性住院次数未增加。移植物存活率（P = 0.214）和患者存活率（P = 0.533）相似。
低剂量抗胸腺细胞球蛋白诱导治疗导致急性排斥反应发生率较低，移植物和患者存活率与巴利昔单抗诱导治疗相似，尽管供体情况较差。在长期随访中，抗胸腺细胞球蛋白治疗的巨细胞病毒病更常见，但感染性住院次数或癌症发生率未增加。
