Kunthara Mathew, Knoll Greg A, Massicotte-Azarniouch David
Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada.
Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada.
Can J Kidney Health Dis. 2025 May 8;12:20543581251338402. doi: 10.1177/20543581251338402. eCollection 2025.
Anti-thymocyte globulin (ATG) is often used when delayed graft function (DGF) occurs post-transplantation. The ATG may be associated with an increased risk of infections but may also decrease rejection risk in high-immunological risk recipients. The safety of ATG for the indication of DGF in low-immunological risk recipients has not been well characterized. We conducted a retrospective cohort study of deceased donor kidney transplant recipients deemed low-immunological risk and not planned for ATG induction, from June 2019 to June 2023 (N = 139). Participants switched to ATG post-transplant due to DGF (exposure; N = 68) were compared to those who did not receive ATG for induction (controls; N = 71 basiliximab only induction). Outcomes examined included BK, cytomegalovirus (CMV), and serious infection as well as acute rejection, graft loss, and death. Participants who received ATG for DGF, compared to controls, were older (63.9 vs 59.7 years), more often had diabetes as cause of kidney failure (45.5% vs 33.8%) were more often recipients of death determination by circulatory criteria donor (70.5% vs 30.9%) and extended criteria donor kidneys (48.5% vs 32.3%). There was no significant difference in the probability of BK (22.1% vs 21.1%, = .89), CMV (20.6% vs 9.9%, = .08), serious infections (44.1% vs 43.6%, = .96), acute rejection, graft loss, or death. The use of ATG for DGF following kidney transplantation did not significantly increase infection risk nor did it improve graft outcomes. Further studies are needed to clarify the risk-benefit trade-off of using ATG for DGF.
抗胸腺细胞球蛋白（ATG）常用于移植后出现移植肾功能延迟恢复（DGF）的情况。ATG可能会增加感染风险，但也可能降低高免疫风险受者的排斥反应风险。ATG用于低免疫风险受者DGF指征的安全性尚未得到充分描述。我们对2019年6月至2023年6月期间被认为是低免疫风险且未计划进行ATG诱导的已故供体肾移植受者进行了一项回顾性队列研究（N = 139）。将因DGF在移植后改用ATG的参与者（暴露组；N = 68）与未接受ATG诱导的参与者（对照组；N = 71，仅使用巴利昔单抗诱导）进行比较。检查的结果包括BK病毒、巨细胞病毒（CMV）和严重感染，以及急性排斥反应、移植物丢失和死亡。与对照组相比，因DGF接受ATG的参与者年龄更大（63.9岁对59.7岁），更常因糖尿病导致肾衰竭（45.5%对33.8%），更常接受按照循环标准判定死亡的供体（70.5%对30.9%）和扩大标准供体肾脏（48.5%对32.3%）。BK病毒感染概率（22.1%对21.1%，P = 0.89）、CMV感染概率（20.6%对9.9%，P = 0.08）、严重感染概率（44.1%对43.6%，P = 0.96）、急性排斥反应、移植物丢失或死亡方面均无显著差异。肾移植后使用ATG治疗DGF并未显著增加感染风险，也未改善移植物结局。需要进一步研究来阐明使用ATG治疗DGF的风险效益权衡。
