单次大剂量ATG诱导治疗在致敏患者肾移植前应用的效果探讨  

Pre-sensitized renal allograft recipients with preoperatively single bolus antithymocyte globulin as induction therapy

作　　者：孙淑清[1] 赵兴旺[1] 王栋[1] 陈锦华[1] 朱文平[1] 佟智超 饶明煌 杨顺良[1] 吴卫真[1] 谭建明[1] 

机构地区：[1]南京军区福州总医院,福州350025

出　　处：《中华器官移植杂志》2014年第3期137-141,共5页Chinese Journal of Organ Transplantation

摘　　要：目的评价单次大剂量抗胸腺细胞球蛋白（ATG）诱导治疗在致敏患者肾移植前应用的安全性和有效性。方法回顾性分析75例群体反应性抗体（PRA）阳性并接受术前单次大剂量ATG作为诱导治疗的肾移植受者（ATG组）的5年临床随访资料，并选取同时期的42例PRA阳性的接受巴利昔单抗作为诱导治疗的肾移植受者作为对照组，比较两组术后排斥反应和感染发生情况等。结果两组均未出现超急性排异反应，ATG组术后急性排斥反应发生率为21．3％（16／75），明显低于对照组的42．9％（18／42，P〈0．05）。ATG组有2例（2．7％，2／75）出现DGF，对照组有3例（7．1％，3／42）出现DGF，差异无统计学意义（P〉0．05）。ATG组术后血小板减少症的发生率为20．0％（15／75）明显多于对照组的2．4％（1／42，P〈0．01）。两组发热、血清病、感染及肿瘤等不良事件的发生率的差异无统计学意义（P〉0．05）。ATG组患者的5年移植肾存活率为85．3％（64／75）高于对照组的64．3％（27／42，P〈0．01）。尽管ATG组的5年患者存活率为92．0％（69／75）高于对照组的83．3％（35／42），但是差异无统计学意义（P〉0．05）。结论术前单次大剂量ATG诱导治疗不仅可以降低术前PRA阳性的肾移植受者术后急性排斥反应发生率，还可以有效地提高移植肾5年存活率，未明显增加治疗相关并发症的发生率。Objective To evaluate the safety and efficacy of preoperative single bolus antithyrnocyte globulin（ATG） as induction therapy in sensitized renal allograft recipients. Method Clinical data of 117 panel reactive antibodies positive renal graft recipients were retrospectively analyzed, who received single bolus ATG or Basiliximab as induction therapy. Patients in ATG group （n = 75） received single bolus ATG （Fresenius, 9 mg/kg preoperatively） and those in control group （n = 42） were given two doses of Basiliximab （Simulect 20 rag） on the day 0 and 4 post-transplantation. Result No hyperacute rejection occurred in two groups. Recipients in ATG group experienced significantly fewer AR episodes than in control group （21.3% vs. 42.9%, P 〈 0.05）. Thrombocytopenia occurred in 15 patients （20. 0%） in ATG group, which was greater than in control group （P〈0. 01 ）. Incidence of other adverse events, and infectious and malignant complications showed no significant difference between two groups （P〈0. 05）. The 5-year graft survival rate was significantly higher in ATG group （64/75, 85.3%） than in control group （27/42, 64. 3%） （P〈0. 01）, but there was no significant difference in the 5-year patient survival rate between ATG group and control group （92. 0% vs. 83. 3% ,P〉0. 05）. Conclusion Preoperatively single bolus ATG had yielded not only much lower AR rate but longer graft survival than Basiliximab as induction therapy without increasing infection episodes and other severe adverse events, which should be administrated as induction therapy preferentially in sensitized renal graft recipients.

关 键 词：肾移植 群体反应性抗体 诱导治疗 抗胸腺细胞球蛋白 巴利昔单抗 

分 类 号：R699.2[医药卫生—泌尿科学]