Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, TX, USA.
College of Pharmacy, Pharmacotherapy Division, University of Texas at Austin, Austin, TX, USA.
Prog Transplant. 2024 Jun;34(1-2):47-52. doi: 10.1177/15269248241237816. Epub 2024 Mar 11.
Delayed graft function in kidney transplant is associated with an increased risk of rejection and graft loss. Use of rabbit antithymocyte globulin induction in delayed graft function has been correlated with less rejection compared to basiliximab, but optimal dosing remains unknown. The purpose of this evaluation was to retrospectively assess the short-term effectiveness and tolerability of a clinical protocol that increased the net state of immunosuppression in delayed graft function kidney transplant recipients using cumulative 6 mg/kg rabbit antithymocyte globulin induction. This retrospective cohort included 88 kidney transplant recipients with delayed graft function, transplanted between January 2017 and March 2021, who either received cumulative 4.5 mg/kg pre-protocol or 6 mg/kg post-protocol rabbit antithymocyte globulin. Outcomes evaluated were biopsy-proven acute rejection and incidence of graft loss, infection, and cytopenia at 6 months. A significant reduction of biopsy-proven acute rejection incidence occurred post-protocol implementation (10/33, 30.3% vs 6/55, 10.9%; = .04). Of those with rejection, significantly less post-protocol patients were classified as acute cellular rejection (9/10, 90.0% vs 2/6, 33.3%; = .04). No death-censored graft loss was observed in either group. Rates of cytopenia and infection were similar pre- versus post-protocol implementation. Increasing the exposure to rabbit antithymocyte globulin and maintenance immunosuppression in delayed graft function kidney transplant recipients was tolerable and significantly reduced rejection occurrence at 6 months.
移植肾延迟功能与排斥反应和移植物丢失风险增加相关。与巴利昔单抗相比，使用兔抗胸腺细胞球蛋白诱导治疗移植肾延迟功能可降低排斥反应发生率，但最佳剂量尚不清楚。本评估的目的是回顾性评估使用累积 6mg/kg 兔抗胸腺细胞球蛋白诱导增加移植肾延迟功能患者免疫抑制净状态的临床方案的短期有效性和耐受性。本回顾性队列纳入了 88 例移植肾延迟功能患者，他们在 2017 年 1 月至 2021 年 3 月期间接受了累积 4.5mg/kg 预方案或 6mg/kg 后方案兔抗胸腺细胞球蛋白治疗。评估的结局包括活检证实的急性排斥反应和 6 个月时移植物丢失、感染和细胞减少症的发生率。方案实施后活检证实的急性排斥反应发生率显著降低（10/33，30.3%比 6/55，10.9%；=0.04）。在发生排斥反应的患者中，后方案组患者明显较少被归类为急性细胞性排斥反应（9/10，90.0%比 2/6，33.3%；=0.04）。两组均未观察到死亡相关的移植物丢失。方案实施前后细胞减少症和感染的发生率相似。增加移植肾延迟功能患者的兔抗胸腺细胞球蛋白暴露量和维持免疫抑制是耐受的，并显著降低了 6 个月时的排斥反应发生率。
