尸体供肾移植中抗胸腺细胞球蛋白诱导治疗：墨西哥单中心经验

Thymoglobulin Induction Therapy in Deceased Donor Kidney Transplantation: Single-Center Experience in Mexico.

作者信息

Martinez-Mier G, Soto-Miranda E, Budar-Fernandez L F, Mateu-Rivera L J, Gomez-Diaz A, Trujillo-Martinez M F, Uscanga-Montesano A, Avila Y Falfan D

机构信息

Department of Organ Transplantation, Instituto Mexicano del Seguro Social (IMSS), Unidades Medicas de Alta Especialidad (UMAE), Veracruz, Mexico; Department of Research, IMSS, UMAE, Veracruz, Mexico.

Department of Organ Transplantation, Instituto Mexicano del Seguro Social (IMSS), Unidades Medicas de Alta Especialidad (UMAE), Veracruz, Mexico.

出版信息

Transplant Proc. 2016 Mar;48(2):596-9. doi: 10.1016/j.transproceed.2016.02.018.

DOI:10.1016/j.transproceed.2016.02.018

PMID:27110010

Abstract

BACKGROUND

Induction therapy is used to reduce the incidence of graft rejection and delayed graft function. Thymoglobulin is the most used inductor agent in deceased donor kidney transplantation due to its lower rejection and delayed graft function rates.

METHODS

Retrospective study of patients who underwent deceased donor kidney transplantation from 2011 to 2014. Efficacy and safety outcomes evaluated were primary graft nonfunction, delayed graft function, acute rejection episodes, the lowest leukocyte count during the induction, adverse effects, eGFR, and patient and graft survival. P < .05 was considered statistically significant.

RESULTS

A total of 42 patients were registered. Of these, 51.7% were female, with a mean age of 36.4 ± 11.1 years. Mean dialysis time was 112.4 ± 365 months. Mean donor age was 33.7 ± 13.1 years. Of the registered patients, 14.3% were extended criteria donors and 23.8% high-risk. Mean thymoglobulin dose was 4.4 ± 0.8 mg/kg. Primary graft nonfunction was 2.4%. Nineteen percent presented with delayed graft function and 19% with acute rejection. Mean lowest leukocyte count was of 4.6 ± 1.5 × 10(3) cells/mm(3). Mean hospital stay was 11.3 ± 6.3 days. Adverse effects were seen in 59.5% of registered patients, whereas graft survival 1 year and 3 years after transplantation was 85.3% and 56.9%, respectively. Patient survival 1 year and 3 years after transplantation was 85.3% and 53.8%, respectively. Patients who received a higher dose (>4.4 mg/kg) had a shorter hospital stay (9.4 ± 4.6 and 8.1 ± 2.3) than those who received lower dose (13.6 ± 7.9 and 12.8 ± 7.4; P < .05).

CONCLUSION

Thymoglobulin induction at doses near 5 mg/kg in deceased donor kidney transplant is efficient and secure at our center.

摘要

背景

诱导治疗用于降低移植肾排斥反应的发生率和移植肾功能延迟恢复的发生率。由于其较低的排斥反应率和移植肾功能延迟恢复率，抗胸腺细胞球蛋白是尸体供肾移植中最常用的诱导药物。

方法

对2011年至2014年接受尸体供肾移植的患者进行回顾性研究。评估的疗效和安全性指标包括原发性移植肾功能丧失、移植肾功能延迟恢复、急性排斥反应发作、诱导期最低白细胞计数、不良反应、估算肾小球滤过率以及患者和移植肾存活率。P <.05被认为具有统计学意义。

结果

共登记42例患者。其中，51.7%为女性，平均年龄36.4±11.1岁。平均透析时间为112.4±365个月。供者平均年龄为33.7±13.1岁。登记患者中，14.3%为扩大标准供者，23.8%为高风险供者。抗胸腺细胞球蛋白平均剂量为4.4±0.8mg/kg。原发性移植肾功能丧失率为2.4%。19%出现移植肾功能延迟恢复，19%出现急性排斥反应。最低白细胞计数平均值为4.6±1.5×10(3)个细胞/mm(3)。平均住院时间为11.3±6.3天。59.5%的登记患者出现不良反应，而移植后1年和3年的移植肾存活率分别为85.3%和56.9%。移植后1年和3年的患者存活率分别为85.3%和53.8%。接受较高剂量（>4.4mg/kg）的患者住院时间（9.4±4.6和8.1±2.3）比接受较低剂量的患者短（13.6±7.9和12.8±7.4；P<.05）。