摘要
目的总结在再次肾移植中采用抗体进行免疫诱导的临床经验，并比较不同抗体的应用效果。方法回顾分析39例再次。肾移植受者的临床资料。39例受者均接受了免疫诱导，其中接受巴利昔单抗（Bax）者12例（Bax组），接受抗胸腺细胞球蛋白（ATG）者8例（ATG组），接受抗淋巴细胞球蛋白（ALG）者19例（ALG组）。观察和比较各组间急性排斥反应（AR）、移植物功能丧失、巨细胞病毒（CMV）感染等发生率，以及术后1年时血清肌酐（SCr）水平和移植肾存活率。结果Bax组、ALG组和ATG组分别有41．7％（5／12）、47．4％（9／19）和12．5％（1／8）的受者发生AR，ATG组AR发生率明显低于Bax组和ALG组（P〈0．05），而Bax组和ALG组间的差异无统计学意义。39例移植肾1年总体存活率为84．6％，Bax组、ALG组和ATG组分别为82．4％、80．5％和90．8％，ATG组显著高于其他2组（P〈0．05）；3组术后1年时SCr值分别为（176．8±43．5）μmol／L、（195．4±35．2）tlmol／L、（121．3±22．6）μmol／L，ATG组的SCr水平显著低于其他2组（P〈0．05），而Bax组与ALG组间SCr水平的差异无统计学意义。Bax组、ALG组和ATG组CMV感染发生率分别为16．7％（2／12）、15．8％（3／19）和25％（2／8），3组间两两比较，差异均无统计学意义（P〉0．05）。结论再次肾移植受者具有较高的免疫风险因素及AR发生率，与Bax和ALT相比，ATG能更好的预防AR，改善移植’肾功能，提高移植物早期（1年）存活率，并且不增加感染的发生风险。
[Abstract] Objective To summarize the clinical experience of antibody induction therapy in renal re-transplantations and compare the outcomes among different antibodies. Methods We retrospectively investigated 39 recipients after renal re-transplantations in our center. According to the induction agents, patients were divided into three groups as follows： basiliximab （Bax） group （patients treated with Bax, n = 12）, T lymphocyte polyclonal antibody （ALG） group （patients treated with ALG, n = 19） and thymoglobuline （ATG） group （patients treated with ATG, n = 8）. Incidence of acute rejection, graft loss and cytomegalovirus infection was analyzed, as well as graft survival rate and serum creatinine one year after transplantation. Results Acute rejection occurred in 5 patients of Bax group （5/12, 41.7%）, in 9 patients of ALG group （9/19, 47. 4 %） and 1 patient of ATG group （1/8, 12. 5 %）. The acute rejection rate was similar in Bax and ALG groups, but significantly decreased in ATG group. The 1-year survival rate of re-transplant recipients was 84. 6 %. There were no significant differences in 1-year survival rate between Bax group and ALG group （82. 4 % vs 80. 5 % ）, while ATG group showed higher survival rate （90. 8 %）. The renal function in ATG group was improved at I st year after re-transplantation： serum creatinine （121.3 ±22. 6） μmol/L vs （176. 8 ± 43. 5）μmol/L in Pax group and （195.4 ± 35.2） μmol/L in ALG group respectively. There were 2 patients with CMV infection in Bax group, 3 patients in ALG group and 2 patients in ATG group. There was no significant increase in infection incidence between ATG group and Pax or ALG groups during the follow-up period. Conclusion Retrospective analysis from monocenter and small samples indicated that ATG induction treatment seems to be effective in decreasing acute rejection risk and achieving better outcomes in the renal re-transplant recipients without increased CMV infection incidence.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2011年第11期651-654,共4页
Chinese Journal of Organ Transplantation
关键词
肾移植
再手术
抗体
治疗结果
Kidney transplantation
Reoperation
Antibodies
Treatment outcome
