Antithymocyte globulin/antilymphocyte globulin plus kidney-nourishing Chinese Medicinal:effect on severe aplastic anemia

OBJECTIVE： To explore the effect of antithymocyte globulin （ATG）/antilymphocyte globulin （ALG） plus kidney-nourishing Chinese medicinal （KNCM） on se- vere aplastic anemia （SAA）. METHODS： Twenty-five subjects of severe aplastic anemia were treated with ATG/ALD plus KNCM be- tween 1992 and 2009, and the clinical data before and after treatment were collected and analyzed. RESULTS： Of the 25 patients, 9 were nearly cured, 6 were improved, 5 were in remission, and 5 failed. The overall effective rate was 80.0%. The 3-year, 5-year, 10-year, 15-year survival rate were respec- tively 98.6%, 97.3%, 97.3%, 67.5%, and median sur- vival time was 180 months. Compared to the condi- tions before administering the medication of ATG/ ALG plus KNCM, after 2 weeks, reticulocyte was first improved （P=0.001）, one month later, followed by palette （P=0.037）, two months later, by neutrophil cell in peripheral blood （P=0.001）; three months lat- er, then by the hemoglobin （P=0.012）. By conduct- ing 1-year follow-up, 1 case of complication--parox-ysmal nocturnal hemoglobinuria （PNH） was identi- fied and the patient still alive today. CONCLUSION： ATG/ALG fect on SAA and could rate. plus KNCM had better ef- improve patients＇ survival

Preoperative single-bolus high-dose antithymocyte globulin as induction therapy in sensitized renal transplant recipients

Background Immunological sensitization remains a major problem following renal transplantation. There is no consensus for the management of sensitized renal allograft recipients. The patients become tethered to dialysis while waiting for compatible donors. This study was designed to evaluate the efficacy and safety of preoperative single- bolus high-dose antithymocyte globulin （ATG） as induction therapy in sensitized renal transplant recipients.Methods A total of 56 patients were divided into two groups according to the level of panel reactive antibody （PRA）： non-sensitized group （PRA〈10%, n=30） and sensitized group （PRA≥ 10%, n=26）. The characteristics of the recipients and donors were comparable between the two groups. Mycophenolate mofetil （MMF, 1 g） or ATG （iv. 9 mg/kg） were given preoperatively in the two groups as induction therapy. After the transplantation, the patients were treated with standard triple therapy regimen consisting of tacrolimus （FK-506） or cyclosporine A, MMF, and prednisolone. Acute rejection （AR） and infection episodes were recorded and renal function was monitored during a 12-month follow-up. Х^2 test and t test were used to analyze the data. Results During the follow-up, 6 patients （20.0%） suffered AR episodes in the non-sensitized group and 4 （15.4%） in the sensitized group （P=0.737）; 8 patients （26.7%） experienced 11 infection episodes （average, 1.4 episodes per infected patient） in the non-sensitized group, and 6 （23.1%） experienced 10 infection episodes （average, 1.7 episodes per infected patient） in the sensitized group （P=0.757, 0.890）. The safety of the drugs, which was assessed by the occurrence of side effects, was comparable between the two groups. The hospital stay was 13-25 days （mean, 16.7±3.3） in the non-sensitized group and 14-29 days （mean, 16.2±3.1） in the sensitized group, respectively （P=0.563）. No delayed graft function （DGF） was observed in all the patients. Both the 12-month actuarial patient and graft survival rates were 100% in the two groups. Conclusion Preoperative single-bolus high-dose ATG is an effective and safe induction therapy yielding acceptable acute rejection rate in sensitized renal transplant recipients.