比较诱导治疗联合或不联合抗胸腺细胞球蛋白对活体供肾移植受者肾移植结局的影响。

Comparing the effect of induction therapy with or without antithymocyte globulin on renal allograft outcomes in live-donor kidney transplant recipients.

作者信息

Marghoob Bahareh, Rahimian Neda, Ataiepour Yousef, Mahdifarani Marziyeh, Nejatifar Masoumeh, Kabir Ali

机构信息

HashemiNejad Hospital, Iran University of Medical Sciences, Tehran, Iran.

Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Med J Islam Repub Iran. 2019 Dec 18;33:141. doi: 10.34171/mjiri.33.141. eCollection 2019.

DOI:10.34171/mjiri.33.141

PMID:32280647

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7137861/

Abstract

This study aimed to investigate the effectiveness of antithymocyte globulin (ATG) in low-risk live-donor kidney transplant recipients (LDKTRs). In this cohort study, 114 LDKTRs were analyzed in 2 groups of ATG induction therapy (n=77) and control (n=37). In this study, 500 mg pulse therapy with methylprednisolone was provided for both groups for 3 days. In addition, one mg/kg of daily ATG was prescribed for 4 days in ATG induction group. Serum creatinine (Cr) was measured at 3, 7, 30, 90, and 180 days after surgery and discharge day. Acute rejection (AR) was confirmed based on biopsy or rise in serum Cr by three-tenths from baseline if other causes had been ruled out. Survival analysis was used by Stata14 and p < 0.05 was considered significant. Cr changes were not significantly different between ATG induction therapy and control group in all follow-up periods (2.26 and 1.07 in ATG vs 2.26 and 1.03 in control group from the third day; (p=0.999) to the sixth month (p=0.735)). There was no significant difference between the 2 study groups in AR incidence (11.7% in ATG vs 10.8% in control group, P = 0.890) and its time (9.6 in ATG vs 9.8 in control group, p=0.695). Recipients factors were baseline Cr >10 mg/dL (p=0.055), blood group AB (p=0.007), no postoperative pulse therapy with methylprednisolone (PM) (p=0.005); and donors' factors were age ≤ 30 years (p=0.022) and blood group AB (p=0.006). Also, based on the log rank analysis, recipient-donor weight difference of 0 to 5 kg (p=0.047) had a significant association with earlier AR. Exploring these effects simultaneously by Cox regression analysis showed only significant results for recipients' baseline Cr (p=0.040) and postoperative therapy with PM (p=0.014). Both strategies of induction therapy had the same good results based on Cr decrease. Recipients' baseline Cr and postoperative therapy with PM were the predictors of survival time of the kidney (AR).

摘要

本研究旨在探讨抗胸腺细胞球蛋白（ATG）在低风险活体供肾移植受者（LDKTRs）中的有效性。在这项队列研究中，114名LDKTRs被分为两组，分别接受ATG诱导治疗（n = 77）和作为对照组（n = 37）。在本研究中，两组均给予500mg甲泼尼龙冲击治疗，持续3天。此外，ATG诱导组给予1mg/kg的ATG每日一次，共4天。在术后3、7、30、90和180天以及出院日测量血清肌酐（Cr）。如果排除了其他原因，急性排斥反应（AR）通过活检或血清Cr较基线水平升高十分之三来确诊。使用Stata14进行生存分析，p < 0.05被认为具有统计学意义。在所有随访期内，ATG诱导治疗组和对照组之间的Cr变化无显著差异（从第三天起，ATG组为2.26和1.07，对照组为2.26和1. B组为2.26和1.03；（p = 0.999）至第六个月（p = 0.735））。两组在AR发生率（ATG组为11.7%，对照组为10.8%，P = 0.890）及其发生时间（ATG组为9.6，对照组为9.8，p = 0.695）方面无显著差异。受者因素包括基线Cr > 10mg/dL（p = 0.055）、血型为AB型（p = 0.007）、术后未接受甲泼尼龙冲击治疗（PM）（p = 0.005）；供者因素包括年龄≤30岁（p = 0.022）和血型为AB型（p = 0.006）。此外，基于对数秩分析，受者 - 供者体重差异为0至5kg（p = 0.047）与较早发生的AR有显著关联。通过Cox回归分析同时探究这些影响，仅发现受者基线Cr（p = 0.040）和术后PM治疗（p = 0.014）有显著结果。基于Cr下降情况，两种诱导治疗策略都有相同的良好效果。受者基线Cr和术后PM治疗是肾脏存活时间（AR）的预测因素。