低剂量短疗程抗胸腺细胞球蛋白治疗肾移植耐激素排斥反应

Low-dose and short-term antithymocyte globulin in treatment of steroid-resistant rejection after renal transplantation

目的探讨低剂量、短疗程的抗胸腺细胞球蛋白（ATG）治疗肾移植后早期激素耐受性排斥反应的疗效。方法15例肾移植后早期发生的激素耐受性排斥反应患者给予ATG 1mg·kg^-1·d^-1，qod，总疗程4～10d，观察其排斥反应逆转率、术后6mo内排斥反应再次发生率和感染发生率。结果ATG治疗（3．4±1．5）次后，15例患者中12例逆转（80％），肾功能良好；2例（13．3％）治疗有效，未行肾切除；1例（6．67％）无效，血透维持。术后6mo内3例（20％）再次发生排斥反应，3例（20％）术后40d内发生肺部感染。随访期内受体存活率100％。结论低剂量、短疗程的ATG治疗能有效地逆转肾移植后早期激素耐受性排斥反应，且减少了感染及严重并发症的发生机会。

AIM To explore the effect of low-dose and short-term antithymocyte globulin （ATG） in treatment of early steroid-resistant rejection after renal transplantation. MEHTODS ATG was administered in 15 steroid-resistant patients in dose of 1 mg·kg^-1·d^-1 on alternate days for frequency of（3.4±1.5）. It＇ s reversal rate of rejection, rebound rejection and infections within 6 mo were observed. RESULTS Twelve patients（80%） experienced completely reversal. Two patients（13.33%） experienced partial reversal without nephrectomy. One patient （6.67%） was no response . Three patients（20%） displayed rebound rejection at 6 mo. Infections were identified in 3 patients（20%） within 40 d post-transplantation. CONCLUSION Low-dose and short-term ATG can reverse the steroid-resistant rejection effectively, and has the advantages of less infections and severe complications.