抗胸腺细胞球蛋白对再次肾移植受者尸体供肾移植免疫诱导的临床有效性和安全性

Clinical efficacy and safety of antithymocyte globulin prophylaxis for graft recipients in deceased donor kidney re-transplantation

目的探讨抗胸腺细胞球蛋白(ATG)对再次肾移植受者尸体供肾移植免疫诱导的有效性和安全性。方法回顾性分析2017年6月-2020年11月应用ATG行免疫诱导的20例再次肾移植患者的临床资料。根据T淋巴细胞亚群、肺部感染和骨髓抑制情况评估ATG诱导的临床安全性,根据急性排斥反应(AR)、移植肾功能延迟恢复(DGF)情况评估ATG诱导的临床有效性。结果共纳入20例患者,男15例,女5例,平均年龄45.7(25~71)岁;预存抗体阳性6例(30.0%);二次移植17例(85.0%),三次移植3例(15.0%)。ATG诱导T淋巴细胞数在术后第1天下降70%以上,第3天逐渐恢复达总数的50%(P<0.01),术后2周可基本恢复至移植前水平;NK细胞数呈持续下降趋势(P<0.01)。术后患者发生AR 5例(20.0%),DGF 1例(5.0%),肺部感染7例(35.0%),骨髓抑制6例(30.0%),无ATG过敏反应。中位随访时间17.6(6~53)个月,19例(95.0%)人肾存活,1例(5.0%)死亡。结论ATG可明显抑制T细胞的活化和增殖,降低AR发生率,加速再次移植患者的移植肾短期功能恢复,且ATG诱导没有增高感染发生率,临床安全性好。

Objective To investigate the efficacy and safety of antithymocyte globulin(ATG)in the immune induction of deceased donor renal re-transplantation.Methods The clinical data of 20 renal re-transplantation patients treated with ATG from June 2017 to November 2020,were retrospectively studied.The safety was assessed with T lymphocyte subsets,pulmonary infection,and bone marrow suppression.The efficacy was assessed with acute rejection(AR)and delayed graft function(DGF).Results The study contained 15 males and 5 females.The average age was 45.7(25-71)years;6 patients were positive for prestored antibody and 14 negative antibody;17 patients received a second transplantation,3 did a third transplantation.T lymphocytes decreased more than 70%in average induced by ATG on the 1st day after surgery and gradually recovered to 50%of the amount on the 3rd day after surgery(P<0.01).Two weeks after surgery,the number of T lymphocytes recovered to the pretransplant level.NK cells showed a continuous decline(P<0.01).There were 5 patients(25.0%)who suffered AR,1 patient(5.0%)did DGF,7 patients(35.0%)presented with pulmonary infection,5 patients(25.0%)presented with bone marrow suppression,and no ATG allergic reaction cases.The median follow-up period was 17.6(6-53)months.During the follow-up period,19 patients(95.0%)survived with allograft and 1(5.0%)died.Conclusions ATG can significantly suppress the activation and proliferation of T cells,reduce the incidence of AR,and improve the short-term functional recovery of allograft with kidney re-transplantation.ATG induction does not increase the incidence of infection,and the clinical safety of ATG application is reliable.