Ruiz-Martínez L, De-Cos-Gómez M, Valero-San-Cecilio R, Rodrigo-Calabia E, Heras-Vicario M, Serrano-Soto M, Belmar-Vega L, Palomar-Fontanet R, Miñambres-García E, Ruiz-San-Millán J C
Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Nephrology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Transplant Proc. 2019 Mar;51(2):337-340. doi: 10.1016/j.transproceed.2018.10.022. Epub 2018 Oct 29.
Our study compares 2 immunosuppressive strategies to reduce tacrolimus nephrotoxicity and its risk of acute tubular necrosis: delayed introduction of tacrolimus plus thymoglobulin vs initial tacrolimus plus basiliximab on the results of kidney transplant (KT) using type-III donation after circulatory death (III-DCD).
We analyzed all the transplants performed using type-III DCD in our hospital (42 cases). They were distributed in a first stage with delayed tacrolimus (3°-4° day) + thymoglobulin and a second one with initial tacrolimus + basiliximab, with a follow-up of 6 months. The rate of delayed graft function, the evolution of renal function, and the incidence of rejection were compared.
28 patients received thymoglobulin with delayed tacrolimus, and 13 patients received basiliximab and tacrolimus from day 0 (1 excluded). There were no significant differences in delayed graft function (27% group 1 and 23% group 2) or in rejection (10.7% and 15.4%), respectively. Serum creatinine at day 3, 7, 14, 30, and 180 showed no statistically significant differences. The levels of tacrolimus measured at 10, 30, 90, and 180 days after transplantation were similar, except for the first month: 10.10 ± 2.3 in group 1 and 12 ± 1.7 ng/mL in group 2 (P = .007).
Delayed introduction of tacrolimus does not seem to suppose a benefit in KT using type-III DCD; therefore, the use of thymoglobulin, with its higher profile of adverse effects, seems unjustified in patients with normal immunological risk.
我们的研究比较了两种免疫抑制策略，以降低他克莫司的肾毒性及其急性肾小管坏死风险：在肾移植（KT）中，使用循环死亡后III类供体（III-DCD）时，延迟使用他克莫司加抗胸腺细胞球蛋白与初始使用他克莫司加巴利昔单抗的效果。
我们分析了我院使用III-DCD进行的所有移植手术（42例）。它们被分为两个阶段，第一阶段为延迟使用他克莫司（第3-4天）加抗胸腺细胞球蛋白，第二阶段为初始使用他克莫司加巴利昔单抗，随访6个月。比较了移植肾功能延迟恢复率、肾功能变化以及排斥反应发生率。
28例患者接受了延迟使用他克莫司的抗胸腺细胞球蛋白治疗，13例患者从第0天开始接受巴利昔单抗和他克莫司治疗（1例被排除）。移植肾功能延迟恢复率（第1组为27%，第2组为23%）和排斥反应发生率（分别为10.7%和15.4%）无显著差异。第3、7、14、30和180天的血清肌酐无统计学显著差异。移植后第10、30、90和180天测得的他克莫司水平相似，但第一个月除外：第1组为10.10±2.3，第2组为12±1.7 ng/mL（P = 0.007）。
在使用III-DCD的肾移植中，延迟使用他克莫司似乎并无益处；因此，对于免疫风险正常的患者，使用不良反应较多的抗胸腺细胞球蛋白似乎不合理。
