Chai Yun-Xia, Ji Jian-Lei, Li Shu-Juan, Cao Yan-Wei, Sun Xiao-Xia, Wang Qing-Hai, Huang Tao, Dong Zhen, Wang Hong-Yang
Department of Kidney Transplantation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China.
Exp Ther Med. 2020 Mar;19(3):2384-2390. doi: 10.3892/etm.2020.8451. Epub 2020 Jan 15.
Anti-T-lymphocyte globulin (ATG) is frequently used in the induction regimen of renal transplantation, but its dose has not been standardized. In the present study, the efficacy of different ATG-Fresenius (ATG-F) doses was assessed in recipients of renal transplantation. A total of 131 adult recipients of renal transplantation who received ATG-F induction between August 2015 and July 2018 were included. The incidence of biopsy-confirmed acute rejection, graft function, as well as graft and patient survival within 12 months post-transplant, was assessed, and adverse events, including hematologic and infection-associated side effects, were compared between patients receiving a cumulative ATG-F dose of <7 or ≥7 mg/kg. The incidence of biopsy-confirmed acute rejection was similar between patients receiving cumulative doses of <7 and ≥7 mg/kg (7.5 vs. 4.7%, P=0.766). The incidence of infection within 12 months was lower in the ATG-F <7 mg/kg group compared with that in the ≥7 mg/kg group (26.9 vs. 50.0%, P=0.006), but the incidence of pneumonia did not differ between the ATG-F <7 and ≥7 mg/kg groups (10.4 vs. 20.3%, P=0.117). The incidence of urinary infection was higher in the ≥7 mg/kg group than in the <7 mg/kg group (20.4 vs. 7.46%, P=0.033), while the extent and duration of anemia and lymphopenia was similar between groups. There was no difference in graft function, delayed graft function, as well as overall and graft survival between the groups. In conclusion, a moderate reduction in the cumulative ATG-F dose was not associated with an increased risk of acute rejection, while the risk of infection was reduced. Optimization of the ATG-F dose for induction may facilitate the reduction of the risk of infection without compromising the induction efficacy in renal transplant recipients.
抗T淋巴细胞球蛋白（ATG）常用于肾移植的诱导方案，但剂量尚未标准化。在本研究中，评估了不同剂量的费森尤斯ATG（ATG-F）在肾移植受者中的疗效。纳入了2015年8月至2018年7月期间接受ATG-F诱导的131例成年肾移植受者。评估了活检证实的急性排斥反应的发生率、移植肾功能以及移植后12个月内的移植物和患者生存率，并比较了累积ATG-F剂量<7或≥7 mg/kg的患者之间的不良事件，包括血液学和感染相关的副作用。累积剂量<7和≥7 mg/kg的患者活检证实的急性排斥反应发生率相似（7.5%对4.7%，P=0.766）。ATG-F<7 mg/kg组12个月内的感染发生率低于≥7 mg/kg组（26.9%对50.0%，P=0.006），但ATG-F<7和≥7 mg/kg组之间的肺炎发生率无差异（10.4%对20.3%，P=0.117）。≥7 mg/kg组的尿路感染发生率高于<7 mg/kg组（20.4%对7.46%，P=0.033），而两组之间贫血和淋巴细胞减少的程度及持续时间相似。两组之间的移植肾功能、移植肾功能延迟以及总体和移植物生存率无差异。总之，累积ATG-F剂量适度降低与急性排斥反应风险增加无关，同时感染风险降低。优化ATG-F诱导剂量可能有助于降低感染风险，而不影响肾移植受者的诱导疗效。
