Hariharan S, Alexander J W, Schroeder T J, First M R
Department of Internal Medicine, University of Cincinnati Medical Center, Ohio, USA.
Clin Transplant. 1996 Apr;10(2):186-90.
A total of 358 cadaveric renal transplantations performed between 1984 and 1993 received induction therapy with Minnesota antilymphoblast globulin (MALG) 95, muromonab-CD3 (OKT3) 58, antithymocyte globulin--Upjohn (ATGAM) 104, rabbit antithymocyte serum (RATS) 37, or cyclosporine (CyA) 64. There were no differences in age, gender, HLA mismatches and maintenance immunosuppression between these groups of recipients. A significantly higher proportion of OKT3 induction patients were retransplants (50%, p < 0.0001). There were fewer diabetic recipients in the group that received RATS (8%) compared to the other groups (p = 0.0009). There was no significant difference in overall graft survival with the various forms of induction treatment (log rank test, p = 0.48). Similarly, primary cadaveric graft outcome was not different with various forms of induction treatment (p = 0.62). Acute rejection was higher with ATGAM, occurring in 65% of patients, compared to MALG (52%), OKT3 (55%), RATS (43%) and CyA (55%). A significantly lower number of patients were rejection-free with ATGAM (35%) compared to MALG (48%) (p = 0.04). Patients who received ATGAM induction also had a higher rate of rebound rejection. Patients receiving ATGAM induction had a significantly higher serum creatinine level at 1 and 6 months post-transplantation (p < 0.005) compared to other induction treatments. In conclusion, the prevalence of acute rejection was higher with ATGAM, which was also reflected by higher serum creatinine levels. However, the long-term graft function and survival were not different with the various induction treatments.
1984年至1993年间共进行了358例尸体肾移植，其中95例接受明尼苏达抗淋巴细胞球蛋白（MALG）诱导治疗，58例接受莫罗单抗-CD3（OKT3）诱导治疗，104例接受抗胸腺细胞球蛋白-优普金（ATGAM）诱导治疗，37例接受兔抗胸腺细胞血清（RATS）诱导治疗，64例接受环孢素（CyA）诱导治疗。这些受者组在年龄、性别、HLA错配情况及维持性免疫抑制方面无差异。接受OKT3诱导治疗的患者再次移植的比例显著更高（50%，p<0.0001）。与其他组相比，接受RATS诱导治疗的组中糖尿病受者较少（8%）（p = 0.0009）。不同形式的诱导治疗在总体移植物存活方面无显著差异（对数秩检验，p = 0.48）。同样，不同形式的诱导治疗在尸体肾初次移植结局方面也无差异（p = 0.62）。与MALG（52%）、OKT3（55%）、RATS（43%）和CyA（55%）相比，接受ATGAM诱导治疗的患者急性排斥反应发生率更高，为65%。与MALG（48%）相比，接受ATGAM诱导治疗且无排斥反应的患者数量显著更少（35%）（p = 0.04）。接受ATGAM诱导治疗的患者反弹排斥反应发生率也更高。与其他诱导治疗相比，接受ATGAM诱导治疗的患者在移植后1个月和6个月时血清肌酐水平显著更高（p<0.005）。总之，ATGAM诱导治疗的急性排斥反应发生率更高，这也反映在更高的血清肌酐水平上。然而，不同诱导治疗在长期移植物功能和存活方面无差异。
