低剂量兔抗人胸腺细胞免疫球蛋白用于儿童肾移植诱导治疗的临床研究  

Clinical trial of low-dose rabbit anti-human thymocyte globulin for induction therapy of kidney transplantation in children

作　　者：张鲁予 张荻 丰永花[1] 冯成皓 王志刚[1] 李金锋[1] 刘磊[1] 谢红昌[1] 丰贵文[1] 尚文俊[1] Zhang Luyu;Zhang Di;Feng Yonghua;Feng Chenghao;Wang Zhigang;Li Jinfeng;Liu Lei;Xie Hongchang;Feng Guiwen;Shang Wenjun(Department of Renal Transplantation,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;School of Basic Medical Sciences,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院肾移植科,郑州450052 [2]郑州大学基础医学院,郑州450001

出　　处：《中华器官移植杂志》2023年第2期81-86,共6页Chinese Journal of Organ Transplantation

摘　　要：目的探讨低剂量兔抗人胸腺细胞免疫球蛋白(rabbit anti-human thymocyte globulin,rATG)用于儿童肾移植诱导治疗的有效性与安全性。方法回顾性分析2018年10月至2021年5月郑州大学第一附属医院肾移植科应用低剂量rATG诱导方案的儿童肾移植受者临床资料。观察术后1年受者/移植肾存活率、肾功能恢复情况、AR及不良反应。采用Friedman检验分析术后肾功能变化;根据术前基线资料分层,采用Pearson卡方检验或Fisher精确检验分析术后AR及不良反应影响因素。结果共纳入77例儿童肾移植受者,术后1年内共有16例(20.78%)受者出现AR,且均发生在术后前6个月;移植肾功能延迟恢复(delayed graft function,DGF)的发生率为14.29%(11/77)。移植术后严重感染的发生率为18.18%(14/77),BK病毒感染发生率为25.97%(20/77),中性粒细胞减少症发生率为32.47%(25/77)。术后1年受者/移植肾存活率分别为97.40%(75/77)和94.81%(73/77)。卡方检验结果显示,体重≤30 kg、身高≤138 cm儿童受者的术后感染发生率分别为28.95%(11/38)和27.50%(11/40),均高于体重>30 kg、身高>138 cm儿童受者的7.69%(3/39)和8.11%(3/37),组间比较,差异均有统计学意义(P=0.016和0.028)。结论低剂量rATG预防儿童肾移植受者发生AR的总体疗效良好,且出现相关不良反应的风险可能更低;本方案下术前发育较好儿童受者的术后感染发生率较低。Objective To explore the efficacy and safety of low-dose rabbit anti-human thymocyte globulin(rATG)for induction therapy of kidney transplantation(KT)in children.Methods From October 2018 to May 2021,clinical data were reviewed retrospectively for 77 pediatric KT recipients on a low-dose rATG induction protocol.Recipient/graft survival rate,renal function recovery,acute rejection(AR)and adverse reactions were observed at 1 year post-operation.The postoperative changes of renal function were examined by Friedman’s test;According to the preoperative baseline data,Pearson’s Chi-square or Fisher's exact test was utilized for examining the influencing factors of postoperative AR.Results A total of 16(20.78%)recipients had AR within the first 6 months post-operation.The incidence of delayed graft function(DGF)was 14.29%(11/77);The incidence of severe infection post-transplantation 18.18%(14/77),the infection rate of BK virus 25.97%(20/77)and the incidence of neutropenia 32.47%(25/77).The recipient/graft survival rate at 1 year post-operation was 97.40%(75/77)and 94.81%(73/77)respectively.Chi-square test indicated that the incidence of postoperative infection in children with body weight≤30 kg and height≤138 cm was 28.95%(11/38)and 27.50%(11/40)respectively,Both were higher than 7.69%(3/39)and 8.11%(3/37)of children with body weight>30 kg and height>138 cm.The difference between groups was statistically significant(P=0.016 and 0.028).Conclusions Low-dose rATG is generally excellent in preventing AR in pediatric KT recipients.And the risk of related AR may be lower.The infection rate of recipients with decent preoperative development is low.

关 键 词：儿童 肾移植 急性排斥反应 兔抗人胸腺细胞免疫球蛋白 低剂量 免疫诱导 

分 类 号：R726.9[医药卫生—儿科]