抗人胸腺细胞免疫球蛋白预防肾移植配型不良

目的 探讨兔抗人胸腺细胞免疫球蛋门(ATG-R)在肾移植PRA阳性受者预防性应用的有效几天和安全性.方法 选取我院2003年5月至2007年lO月的同种异体肾移植792例,实验组(n=132)多为PRA阳性(<45%)、淋巴毒实验阴性、人类白细胞抗原(HLA)配型相配位偏少、多次输血和2次移植等的患者.术前一次较大剂量(0.5 mg/kg)和术后短时间小剂量(0.5-1.0 mg/kg)ATG-R预防性应用;其余患者作为对照组(n=571),给予常规免疫抑制治疗.对两组DGF发生率、6个月内AR发生率、6个月内感染发生率、1人肾存活率进行比较分析.结果 实验组和对照组DGF发生率分别为3.03%和8.03%(P<0.01);6个月内AR发生率分别为6.82%和10.45%(P<0.05),6个月内感染发生牢分别为9.85%和9.55%,两组差异无统计学意义(PP>0.05);两组1年移植物存活率分别为97.73%和96.82%,两组差异无统计学意义(P>0.05);两组1年受者存活率分别为98.48%和98.03%,两组差异无统计学意义(P>0.05.结论 对于HLA配型不良的患者,在规避特异性抗体的前提下挑选供者,术前1次较大剂量和术后短时间小剂量ATG-R预防性应用能够明显降低DGF和AR发生率,并不增加感染发生率,是一种有效可行的ATG免疫诱导措施.

Prophylactic application of anti-thymocyte globulin in renal recipients with unsatisfactory human leukocyte antigen macch

Objective To study the effect and feasibility of rabbit anti-thymocyte globulin prophy- lactic application in renal transplantation. Methods Betion May 2003 and Octombcr 2007,792 cases kid- ney transplantations were performed at our hospital,experiment group included 132 cases which were high PRA,positive Lymph poisonous experiment,less HLA match,many trusfasions or second transplantation a nd son on ,for these patients,single bolus high dose(1.5 mg/kg) before operation and posttransplant short time lower dose (0.5 - 1.0 mg/kg) ATG-R were. given as prophylactic application. Other patients( n = 660) were grouped as control. DGF and 6-month AR rate,6-month infection rate,one-year graft and recipient survival rote were compared. Results For research and control group, DGF rate were 3.03% and 8.03% respective- ly ,P <0. 01 ;6-month AR rate were 6.82% and 10. 45% respeectively,P <0.05 ;6-month infection rate were 9.85% and 9.55% ,P < 0.05, one-year graft and graft survival rate were 97.73% and 96.82%, one-year graft and graft survival rate were 98.48% and 98.03% ,P > 0.05. Conclusion For renal recipients with unsatisfactory HLA match, prophylactic application with single bolus high dose before operation and postt- ransplant short time lower dose ATG-R could reduce DGF and AR rate, but not bring with high infection rate,is a effective and feasible AT(; induction way.