不同免疫诱导方案在心脏死亡器官捐献肾移植中的应用研究

目的探讨不同免疫诱导方案应用于心脏死亡器官捐献(DCD)肾移植受者的有效性和安全性。 方法回顾性分析解放军第三〇九医院器官移植研究所2014年1月至2016年1月完成的121例DCD肾移植受者临床资料。根据免疫诱导方案的不同分为3组：巴利昔单抗组(61例)、兔抗人胸腺细胞球蛋白组(rATG组，18例)和抗人T淋巴细胞兔免疫球蛋白组(ATG-F组，42例)。观察3组受者急性排斥反应、移植肾功能延迟恢复(DGF)、感染发生情况，以及受者和移植肾1年存活率。 结果121例DCD肾移植受者中，17例发生急性排斥反应，巴利昔单抗组10例(16.4%)，rATG组2例(11.1%)，ATG-F 5例(11.9%)，3组急性排斥反应发生率差异无统计学意义(χ²＝0.57，P>0.05)。共32例受者术后出现DGF，巴利昔单抗组16例(26.2%)，ATG组6例(33.3%)，ATG-F组10例(23.8%)，3组DGF发生率差异无统计学意义(χ²＝0.57，P>0.05)。3组肺部感染发生率分别为14.8%，22.2%，26.2%，差异无统计学意义(χ²＝2.12，P>0.05)。共7例出现CMV感染，rATG组3例，ATG-F组4例，3组受者CMV感染发生率差异有统计学意义(χ²＝10.85，P<0.05)，ATG组和ATG-F组高于巴利昔单抗组。3组受者和移植肾1年存活率分别为96.7%和95.1%、100.0%和100.0%，95.2%和95.2%，差异均无统计学意义(χ²＝0.89和0.91，P均>0.05)。 结论对于低免疫风险的DCD肾移植受者，ATG、ATG-F及巴利昔单抗3种免疫诱导方案有效性无明显差异，但与巴利昔单抗相比，ATG、ATG-F可能增加CMV感染风险。

The application research of different immune induction therapies in kidney transplantation of donation after cardiac death

ObjectiveTo compare the efficacy and safety of three different immunologic induction therapies in kidney transplantation of donation after cardiac death. MethodsA retrospective analysis was carried out in clinical data of 121 renal transplant recipients who received transplantation in department of urology, the 309th hospital of PLA from January 2014 to January 2016. The recipients were divided into three groups according to the different immunologic induction drugs: basiliximab group (61 cases), rATG group (18 cases) and ATG-F group (42 cases). The occurrence of acute rejection, delayed graft function (DGF) and infection were observed. ResultsAmong 121 recipients, a total of 17 recipients occured acute rejection, including 10 recipients in basiliximab group, 2 recipients in rATG group and 5 recipients in ATG-F group, no statistical significance was found on occurrence rate of acute rejection (χ²=0.57, P>0.05). Thirty-two recipients occured DGF, including 16 recipients in basiliximab group, 6 recipients in rATG group and 10 recipients in ATG-F group, no statistical significance was found on occurrence rate of DGF (χ²=0.57, P>0.05). The occurrence rate of infection of basiliximab group , rATG group and ATG-F group were 14.8%, 22.2% and 26.2%, respectively, which had no statistical significance (χ²=2.12, P>0.05); the occurrence rate of CMV infection of rATG group and ATG-F group were both higher than basiliximab group (P all <0.017). The 1-year recipient and graft survival rate of basiliximab group , rATG group and ATG-F group were 96.7% and 95.1%、100.0% and 100.0%, 95.2% and 95.2%, respectively, which had no statistical significance (χ²=0.89, 0.91, P all>0.05). ConclusionsThe efficacy of basiliximab, rATG and ATG-F induction therapy in low-risk DCD transplantation did not different from each other, but rATG and ATG-F induction therapy were associated with an increased risk of CMV infection compared with basiliximab.