針對腎臟移植使用低劑量抗胸腺細胞球蛋白作為誘導治療
劉惠瑛、沈元琦、陳柏諺、江博暉、陳彥達、鄭元佐
高雄長庚紀念醫院 泌尿科
Low dose ATG as induction therapy is adequate in renal transplantation
Hui-Ying Liu, Yuan-Chi Shen, Po-Yen Chen, Po-Hui Chiang, Yen-Da Chen, and Yuan-Tso Cheng
Division of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Purpose:
Thymoglobulin as induction therapy in kidney transplant can prevent acute rejection, but has potential effect on delayed graft function (DGF) at the same time. The dosage and duration remains controversial. We aimed to evaluate outcomes in renal transplants with Thymoglobulin induction.
Materials and methods:
During 2012 to 2016, we retrospectively analyzed the total dosage and outcome of all Thymoglobulin induced deceased donor renal transplants performed in our center.
Results:
0f 16 consecutive subjects, who underwent deceased donor renal transplants, all received thymoglobulin induction. We separate the 16 subjects into two groups using accumulative Thymoglobulin dosage with a cut-off value of 4mg/kg. The baseline characteristics of the high-dose ATG and low-dose ATG groups were similar. Overall, there was one graft failure noticed in high-dose ATG group, and one patient with graft failure found in low-dose ATG group (p=1.00). There was no significant difference in delayed graft function in these two groups (high-dose ATG vs. low-dose ATG were 50% vs. 75%, p=0.608). Clinical rejection was observed in 12.5% high-dose ATG and 25% low-dose ATG patients (P=1.00). The infection rates observed in these two groups were 50% and 75%, separately. There were no statistical differences when comparing cytomegalovirus (CMV) or BK virus (BKV) infection rates in high or low-dose groups. Further, no malignancy was found during follow-up in each group.
Conclusions:
Low-dose thymoglobulin induction in deceased donor renal transplantation is adequate and should be take into consideration. For it has no inferior effect on delayed graft function or clinical rejection, but with potential lower risk of associated infections or malignancy.