Anti-thymocyte globulin for treatment of T-cell-mediated allograft rejection  

作　　者：Sumit Acharya Suraj Lama Durga Anil Kanigicherla 

机构地区：[1]Department of Nephrology,Shahid Dharmabhakta National Transplant Center,Bhaktapur 44800,Nepal [2]Department of Renal Medicine,Manchester University NHS Foundation Trust,Manchester M139WL,United Kingdom

出　　处：《World Journal of Transplantation》2023年第6期299-308,共10页世界移植杂志

摘　　要：Anti-thymocyte globulin(ATG)is a pivotal immunosuppressive therapy utilized in the management of T-cell-mediated rejection and steroid-resistant rejection among renal transplant recipients.Commercially available as Thymoglobulin(rabbit-derived,Sanofi,United States),ATG-Fresenius S(rabbit-derived),and ATGAM(equine-derived,Pfizer,United States),these formulations share a common mechanism of action centered on their interaction with cell surface markers of immune cells,imparting immunosuppressive effects.Although the prevailing mechanism predominantly involves T-cell depletion via the complement-mediated pathway,alternate mechanisms have been elucidated.Optimal dosing and treatment duration of ATG have exhibited variance across randomised trials and clinical reports,rendering the establishment of standardized guidelines a challenge.The spectrum of risks associated with ATG administration spans from transient adverse effects such as fever,chills,and skin rash in the acute phase to long-term concerns related to immunosuppression,including susceptibility to infections and malignancies.This comprehensive review aims to provide a thorough exploration of the current understanding of ATG,encompassing its mechanism of action,clinical utility in the treatment of acute renal graft rejections,specifically steroid-resistant cases,efficacy in rejection episode reversal,and a synthesis of findings from different eras of maintenance immunosuppression.Additionally,it delves into the adverse effects associated with ATG therapy and its impact on long-term graft function.Furthermore,the review underscores the existing gaps in evidence,particularly in the context of the Banff classification of rejections,and highlights the challenges faced by clinicians when navigating the available literature to strike the optimal balance between the risks and benefits of ATG utilization in renal transplantation.

关 键 词：Anti-thymocyte globulin T-cell-mediated rejection Steroid-resistant rejection Biopsy confirmed acute rejection 

分 类 号：R69[医药卫生—泌尿科学]