致敏肾移植受者术前单次大剂量抗胸腺细胞球蛋白诱导治疗的价值

Clinical value of induction therapy with preoperative single-bolus high-dose ATG in sensitive renal transplant recipients

目的 探讨致敏肾移植受者术前单次大剂量抗胸腺细胞球蛋白 (ATG)免疫诱导治疗的价值。 方法 2 1例致敏肾移植受者随机分为大剂量 ( 9mg/kg ,术前单次 )和常规剂量 ( 1.5～ 2mg·kg-1·d-1,10～ 12d)ATG诱导治疗组 ,大剂量组受者男 6例、女 4例、年龄 ( 38.2± 3.4 )岁、透析时间 ( 9.3± 13.4 )个月、群体反应性抗体 (PRA)水平 [Ⅰ类 ( 2 7.6± 2 6 .4 ) % ,Ⅱ类 ( 2 5 .3± 19.8) % ]、抗人白细胞抗原 (HLA)错配数 ( 1.9± 0 .7)个 ;常规剂量组男 3例、女 8例、年龄 ( 4 2 .2± 6 .7)岁、透析时间 ( 8.6± 10 .7)月、PRA水平 [Ⅰ类 ( 32 .6± 2 8.4 ) % ;Ⅱ类 ( 2 3.9± 19.7) % ]、HLA错配数 ( 2 .0± 0 .8)个 ,2组差异均无显著性意义 (P >0 .0 5 )。 结果 2组受者均未发生超急性排斥反应。术后 1个月内发生急性排斥反应大剂量组受者 1例 ,常规剂量组 4例 ,2组差异无显著性意义 (P >0 .0 5 )。大剂量组受者血清肌酐均在术后 3～ 7d降至正常 ,常规剂量组 2例发生移植肾功能延迟恢复 ,其中 1例在术后 2 1d恢复正常 ,另 1例术后 4 5d时血肌酐降至 30 0 μmol/L。所有受者均无严重不良反应和感染。大剂量组受者发生肝功能损害 1例。随访 4～ 14个月 ,大剂量组受者移植肾功能正常 ,常规剂量组

Objective To explore the safety and efficacy of high,single dose of anti-thymocyte globulin(ATG) given preoperatively in sensitive renal transplant recipients. Methods A total of 21 sensitive renal transplant recipients were assigned randomly either to high dose(9 mg/kg,single dose,preoperative, n =10)or to routine dose(1.5 to 2 mg·kg -1 ·d -1 ,10 to 12 d, n =11)ATG induction immunosuppressive therapy.No significant difference between the 2 groups was found with regard to male/female ratio(6/4 vs 3/8),age[(38.2±3.4)years vs (42.2±6.7)years], dialysis time[(9.3±13.4)months vs (8.6±10.7)months], PRA level[ClassⅠ(27.6±26.4)% vs (32.6±28.4)%; Class Ⅱ(25.3±19.8)% vs (23.9±19.7)%], HLA mismatches[(1.9±0.7) vs (2.0±0.8)]. Results No hyperacute rejection occurred in the 2 groups.Only 1 case in high dose group developed acute rejection;while 4 cases in routine dose group did.The difference of incidence between the 2 groups was not significant ( P >0.05).The graft function of high dose group returned to normal within 3 to 7 days after operation.Delayed recovery of graft function occurred in 2 cases of routine dose group;in 1 case it returned to normal on the 21st day after operation, in the other the serum creatinine level fell down to 300 μmol/L on the 45th day.There was no severe adverse event such as fever,chill,headache,heart-throb,dyspnea during ATG intravenous perfusion.And no serious infection occurred in the 2 groups during the first 3 months postoperatively.Hepatic function damage occurred in 1 case of high dose group.Follow-up ranged from 4 to 14 months.All recipients of high dose group survived with good graft function;5 of them could do housework. Only one graft lost its function in routine dose group. Conclusions On the basis of optimal selection of the donor and recipient,preoperative single-bolus high-dose ATG is effective and safe for the sensitive recipients as immune induction therapy, which may become one of the new induction treatments before transplantation.