Indudhara R, Novick A C, Hodge E, Goormastic M, Papajcik D, Mastroianni B, Cook D
Department of Urology, Section of Renal Transplantation, Cleveland Clinic Foundation, OH 44195, USA.
Urology. 1996 Jun;47(6):807-12. doi: 10.1016/S0090-4295(96)00067-2.
This retrospective study was undertaken to evaluate and compare the clinical and immunologic outcomes following prophylactic induction treatment with Minnesota anti-lymphoblast globulin (MALG) and Upjohn anti-thymocyte globulin (ATGAM) in cadaver renal transplantation.
From 1990 to 1994, 63 patients with renal transplants from cadavers received MALG and 77 patients received ATGAM for induction treatment. Most pretransplant parameters were equivalent in both groups. There was no significant difference in the total dose and mean duration of MALG/ATGAM administration. The post-transplant outcome in these groups was compared.
There was no difference between the MALG and ATGAM groups with respect to the overall number of rejection episodes, median days to rejection, or the number of steroid-resistant rejection episodes. However, MALG-treated patients experienced a greater number of rejections in the first 60 days postoperatively (P = 0.06). There was no difference in the nadir serum creatinine level in the first 20 postoperative days in the two groups; however, it took fewer days to reach the nadir in the ATGAM group (P = 0.03). The incidence of delayed graft function was higher in the MALG group than in the ATGAM group (38% versus 31%) but not statistically significant. Graft survival at 12 and 24 months was comparable in both groups. However, patient survival was superior at 12 and 24 months in ATGAM-treated transplant recipients (P = 0.03). The mean serum creatinine at 6, 12, and 24 months was similar in both the MALG and ATGAM groups. The mean fall and recovery of CD3, CD4, and CD8 T-lymphocyte subsets while on MALG/ATGAM were similar in both groups. The incidence of infectious complications was greater in the MALG group.
MALG and ATGAM have comparable clinical immunosuppressive effects. Patients receiving ATGAM experienced fewer rejections in the first 2 months, fewer infections, and better survival.
本回顾性研究旨在评估和比较在尸体肾移植中使用明尼苏达抗淋巴细胞球蛋白（MALG）和优普强抗胸腺细胞球蛋白（ATGAM）进行预防性诱导治疗后的临床和免疫结果。
1990年至1994年，63例接受尸体肾移植的患者接受MALG诱导治疗，77例患者接受ATGAM诱导治疗。两组大多数移植前参数相当。MALG/ATGAM给药的总剂量和平均持续时间无显著差异。比较了这些组的移植后结果。
MALG组和ATGAM组在排斥反应发作的总数、至排斥反应的中位天数或类固醇抵抗性排斥反应发作的数量方面没有差异。然而，接受MALG治疗的患者在术后前60天经历的排斥反应更多（P = 0.06）。两组术后前20天的最低血清肌酐水平没有差异；然而，ATGAM组达到最低水平所需的天数更少（P = 0.03）。MALG组移植肾功能延迟的发生率高于ATGAM组（38%对31%），但无统计学意义。两组12个月和24个月时的移植物存活率相当。然而，接受ATGAM治疗的移植受者在12个月和24个月时的患者存活率更高（P = 0.03）。MALG组和ATGAM组在6个月、12个月和24个月时的平均血清肌酐相似。两组在接受MALG/ATGAM治疗时CD3、CD4和CD8 T淋巴细胞亚群的平均下降和恢复情况相似。MALG组感染并发症的发生率更高。
MALG和ATGAM具有相当的临床免疫抑制作用。接受ATGAM治疗的患者在最初2个月内经历的排斥反应更少、感染更少且存活率更高。
