抗人胸腺细胞免疫球蛋白预防肾移植配型不良  

Prophylactic application of anti-thymocyte globulin in renal recipients with unsatisfactory human leukocyte antigen match

作　　者：万峰春 王科 柳东夫 赵俊杰 林春华 高振利 

机构地区：[1]毓璜顶医院器官移植中心,山东烟台264000

出　　处：《中华实验外科杂志》2009年第5期650-652,共3页Chinese Journal of Experimental Surgery

摘　　要：目的探讨兔抗人胸腺细胞免疫球蛋白（ATG—R）在肾移植PRA阳性受者预防性应用的有效性和安全性。方法选取我院2003年5月至2007年10月的同种异体肾移植792例，实验组（n=132）多为PRA阳性（〈45％）、淋巴毒实验阴性、人类白细胞抗原（HIA）配型相配位偏少、多次输血和2次移植等的患者，术前一次较大剂量（1．5mg／kg）和术后短时间小剂量（0．5～1．0mg／kg）ATG—R预防性应用；其余患者作为对照组（n=571），给予常规免疫抑制治疗。对两组DGF发生率、6个月内AR发生率、6个月内感染发生率、1人肾存活率进行比较分析。结果实验组和对照组DGF发生率分别为3．03％和8．03％（P〈0．01）；6个月内AR发生率分别为6．82％和10．45％（P〈0．05），6个月内感染发生率分别为9．85％和9．55％，两组差异无统计学意义（P〉0．05）；两组1年移植物存活率分别为97．73％和96．82％，两组差异无统计学意义（P〉0．05）；两组1年受者存活率分别为98．48％和）8．03％，两组差异无统计学意义（P〉0．05。结论对于HLA配型不良的患者，在规避特异性抗体的前提下挑选供者，术前1次较大剂量和术后短时间小剂量ATG—R预防性应用能够明显降低DGF和AR发生率，并不增加感染发生率，是一种有效可行的ATG免疫诱导措施。Objective To study the effect and feasibility of rabbit anti-thymocyte globulin prophylactic application in renal transplantation. Methods Between May 2003 and Octomber 2007,792 cases kidney transplantations were performed at our hospital, experiment group included 132 cases which were high PRA, positive Lymph poisonous experiment,less HLA match, many trusfusions or second transplantation and son on,for these patients, single bolus high dose （1.5 mg/kg） before operation and posttransplant short time lower dose （0.5 - 1.0 mg/kg） ATG-R were given as prophylactic application. Other patients（ n =660） were grouped as control. DGF and 6-month AR rate,6-month infection rate, one-year graft and recipient survival rate were compared. Results For research and control group, DGF rate were 3.03% and 8.03% respectively,P 〈0.01 ;6-month AR rate were 6.82% and 10.45% respectively,P 〈0.05 ;6-month infection rate were 9.85% and 9.55% ,P 〈 0.05, one-year graft and graft survival rate were 97.73% and 96.82% , one-year graft and graft survival rate were 98.48% and 98.03% , P 〉 0. 05. Conclusion For renal recipients with unsatisfactory HLA match, prophylactic application with single bolus high dose before operation and postt- ransplant short time lower dose ATG-R could reduce DGF and AR rate, but not bring with high infection rate,is a effective and feasible ATG induction way.

关 键 词：肾移植 人类白细胞抗原 胸腺细胞 免疫球蛋白 

分 类 号：R699.2[医药卫生—泌尿科学] R392.12[医药卫生—外科学]