T细胞多克隆抗体在公民逝世后器官捐献供肾移植中有效性及安全性的研究

Efficacy and safety of T lymphocyte polyclonal antibody in deceased donor kidney transplantation

目的观察T细胞多克隆抗体在公民逝世后器官捐献(deceased donation,DD)供肾移植患者中的有效性和安全性。方法回顾性分析昆明市第一人民医院甘美医院自2015年8月20日至2020年2月28日符合研究标准的共324例肾移植受者资料,将其分为使用兔抗人胸腺细胞免疫球蛋白(rabbit anti human thymocyte immunoglobulin,rATG)的患者(A组)147例,使用抗人T细胞兔免疫球蛋白(anti-human T lymphocyte rabbit immunoglobulin,ATG-Fresenius)(B组)的患者177例,比较两组患者急性排斥反应(acute rejection,AR)发生情况、术后移植肾功能延迟恢复(delayed graft function,DGF)的情况以及肺部感染、骨髓抑制、巨细胞病毒(cytomegalovirus,CMV)感染情况等。结果A组和B组在DD供肾移植中术后1年内AR发生率分别为32.65%、16.94%(P<0.05);术后1个月内A组发生AR为17例(17/48),B组发生AR为23例(23/30),两组相比具有统计学意义(χ^(2)=12.5737,P<0.01),A组AR发生率低于B组;A组和B组的DGF发生率分别为25.17%(37/147)和12.42%(22/177)(P<0.01);术后30 d,A组DGF发生率较B组更低(P<0.01);术后骨髓抑制、肺部感染、CMV感染3个方面不良事件比较,差异无统计学意义(P>0.05)。结论rATG和ATG-F均能安全有效地运用于DD肾移植术前诱导及术后治疗,rATG纠正DD供肾移植中DGF的作用及降低AR的发生率有着更优的表现。

Objective To observe the efficacy and safety of T lymphocyte polyclonal antibody in deceased donor(DD)kidney transplantation.Methods The clinical data of 324 renal transplant recipients who met the research criteria from August 20,2015 to February 28,2020 in our hospital were retrospectively analyzed.They were divided into two groups.A total number of 147 patients were treated with rabbit anti human thymocyte immunoglobulin(rATG)(group A).177 patients were treated with anti human T lymphocyte rabbit immunoglobulin(ATG-Fresenius)(group B).The acute rejection(AR),delayed graft function(DGF),lung infection,bone marrow suppression and cytomegalovirus(CMV)infection were compared between the two groups.Results The incidence of AR in group A and group B was 32.65%and 16.94%respectively(P<0.05).There were 17 cases of AR in group A(17/48)and 23 cases in group B(23/30)within one month after operation(χ^(2)=12.5737,P<0.01).The incidence of AR in group A was lower than that in group B(P<0.01).The incidence of DGF was 25.17%(37/147)in group A and 12.42%(22/177)in group B(P<0.01).Thirty days after operation,the incidence of DGF in group A was lower than that in group B(P<0.01).There was no significant difference in the adverse events of bone marrow suppression,pulmonary infection and CMV infection(P>0.05).Conclusion In our hospital,both rATG and ATG-F can be safely and effectively used in the induction and postoperative treatment of DD renal transplantation.The rATG has a better performance in correcting the DGF and reducing the incidence of AR in DD kidney transplantation.