不同免疫诱导方案对肾移植术后移植肾功能延迟恢复的影响

Effect of different immune induction therapies on delayed kidney graft function recovery after transplantation

目的观察和比较甲泼尼龙琥珀酸钠、巴利昔单抗和兔抗人胸腺细胞免疫球蛋白(ATG)三种免疫诱导方案的使用对肾移植术后移植肾功能延迟恢复(DGF)的影响。方法回顾性分析我中心2008年1月-2010年12月肾移植病例的临床资料,对三组免疫诱导方案下,以环孢素或他克莫司为基础的免疫抑制方案肾移植术后患者的移植肾功能延迟恢复发生率进行临床总结和分析。结果 DGF总发生率为21.62%,其中甲强组发生率29.03%(9/31),巴利昔单抗组18.52%(5/27),ATG组12.50%(2/16)。甲强组DGF发生率较高(P<0.05)。甲强组移植肾功能恢复前所需时间比其他两组长(P<0.05)。结论巴利昔单抗和兔抗人胸腺细胞免疫球蛋白(ATG)免疫诱导方案可能通过降低亚临床排斥反应从而降低肾移植术后DGF的发生率。

Objective To observe and compare the effect of induction therapy with methylprednisolone or basiliximab or thymoglobulin（ATG） on delayed kidney graft function（DGF） recovery after transplantation.Methods Clinical data about patients who underwent kidney transplantation in our center from January 2008 to December 2010 were retrospectively analyzed.DGF recovery of the patients after different induction therapies with tacrolimus or cyclosporine was analyzed.Results The total incidence of DGF following kidney transplantation was 21.62%.The incidence of DGF was 29.03%（9/31）,18.52%（5/27）,and 12.50%（2/16）,respectively,after induction therapy with methylprednisolone,basiliximab,and ATG（P0.05）.The time of kidney graft function recovery to normal was longer after induction therapy with methylprednisolone than after induction therapy with basiliximab and ATG（P0.05）.Conclusion Induction therapy with basiliximab and ATG can reduce the occurrence of DGF after kidney transplantation by inhibiting the subclinical acute rejection.