Efficacy analysis of T lymphocyte polyclonal antibody in renal transplantation from donor kidney of organ donation after citizen's death
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摘要:
目的 比较不同T细胞多克隆抗体在公民逝世后器官捐献供肾肾移植中的临床疗效。 方法 回顾性分析行公民逝世后器官捐献供肾肾移植的691例供、受者的临床资料。根据用于诱导的T细胞多克隆抗体不同, 将受者分为兔抗人T细胞免疫球蛋白(rALG)组(414例)和兔抗人胸腺细胞免疫球蛋白(rATG)组(277例)。收集两组受者移植肾功能恢复情况, 包括受者肾移植术后移植肾功能延迟恢复(DGF)和急性排斥反应(AR)的发生情况、术后血清肌酐水平的变化; 收集肾移植术后受者和移植肾1年的生存率; 统计术后1年内不良反应的发生率; 按供者DGF风险评分分为5组, 统计各组受者的rALG和rATG的使用比例。 结果 rALG组和rATG组受者DGF发生率分别为14.5%(60/414)、11.9%(33/277), rALG组、rATG组受者DGF持续时间分别为(7±4)d、(12±7)d, 两组间差异无统计学意义(P > 0.05)。rALG组AR发生率为7.5%(31/414), 明显高于rATG组的4.0%(11/277)(P < 0.05)。两组受者肾移植术后6个月内血清肌酐均呈逐渐下降的趋势。供者DGF风险评分为0~15分的供肾肾移植中, rALG的使用比例显著高于rATG; 而供者DGF风险评分 > 16分的供肾肾移植中, rATG使用的比例显著高于rALG(P < 0.05)。rALG组和rATG组受者、移植肾1年存活率分别为99.8%和99.6%、98.1%和98.2%, 两组间差异均无统计学意义(均为P > 0.05)。rATG组受者急性肺水肿和白细胞减少的发生率显著高于rALG组(均为P < 0.05)。 结论 rALG和rATG均能有效降低公民逝世后器官捐献供肾肾移植术后DGF及AR发生率, 获得良好的临床效果, rATG诱导的肾移植受者白细胞减少和急性肺水肿发生率高于rALG。 Abstract:Objective To compare the clinical efficacy of different T lymphocyte polyclonal antibodies in renal transplantation from donor kidney of organ donation after citizen's death. Methods Clinical data of 691 donors and recipients undergoing renal transplantation from donor kidney of organ donation after citizen's death were retrospectively analyzed. According to different T lymphocyte polyclonal antibodies used for induction, all recipients were divided into the rabbit anti human T lymphocyte immunoglobulin (rALG) group (n=414) and rabbit anti human thymocyte immunoglobulin (rATG) group (n=277). The recovery of renal graft function in recipients of the two groups were collected, including the incidence of delayed graft function (DGF) and acute rejection (AR), and the changes of serum creatinine level after renal transplantation. The 1-year survival rate of the recipients and renal grafts was collected. The incidence of adverse effects within 1 year after operation was calculated. According to the DGF risk score of donors, all recipients were divided into 5 groups. The use proportion of rALG and rATG in the recipients of each group was calculated. Results The incidence of DGF in the recipients of rALG and rATG groups was 14.5% (60/414) and 11.9% (33/277), respectively. The duration of DGF in the recipients of rALG and rATG groups was (7±4) d and (12±7) d respectively, with no statistically significant difference between two groups (P > 0.05). The incidence of AR in the rALG group was 7.5% (31/414), significantly higher than 4.0% (11/277) in the rATG group (P < 0.05). The serum creatinine levels of recipients within 6 months after renal transplantation tended to gradually decline in both groups. In renal transplantation for donor kidney with a DGF risk score of 0-15, the use proportion of rALG was significantly higher than that of rATG. However, the use proportion of rATG was significantly higher than that of rALG in renal transplantation for donor kidney with a DGF risk score over 16 (P < 0.05). The 1-year survival rates of the recipients and renal grafts in the rALG and rATG groups were 99.8% and 99.6%, 98.1% and 98.2%, respectively. There was no significant difference between two groups (both P > 0.05). The incidence of acute pulmonary edema and leukopenia in the recipients of rATG group was significantly higher than that in the rALG group (both P < 0.05). Conclusions Both rALG and rATG can effectively reduce the incidence of DGF and AR and achieve good clinical efficacy after renal transplantation from donor kidney of organ donation after citizen's death. The incidence of leukopenia and acute pulmonary edema induced by rATG is higher than that by rALG in the renal transplant recipients. -
表 1 两组肾移植受者的并发症发生情况
Table 1. Occurrence of complications of renal transplant recipients in two groups [n(%)]
组别 n 感染 白细胞减少 血小板减少 急性肺水肿 rATG组 277 30
(10.8)37
(13.4)45
(16.2)7
(2.5)rALG组 414 39
(9.4)21
(5.1)42
(10.1)2
(0.5)P值 0.541 0.046 0.057 0.013 -
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