Abstract:

Objective This study aimed to compare and analyze the efficacy and safety of T-cellpolyclonal antibody and basiliximab in deceased donor kidney transplants. Methods This study wasaretrospective，single center，controlled study. The clinical data of 402 adult kidney transplant recipients who met the inclusion criteria at Kunming First People's Hospital from August 20，2015 to February 28，2020 were retrospectively analyzed. Patients were placed into rabbit anti-human thymocyte immunoglobulin（rATG）group （147 patients，group A），anti-human T lymphocyte rabbit immunoglobulin （ATG-F）group（177 patients，group B），and basiliximab

（78 patients，group C）group. The incidences of acute rejection（AR），delayed graft function（DGF），lung infection，bone marrow suppression，cytomegalovirus（CMV）infection were retrospectively analyzed. Results The total incidences of AR in groups A，B and Cpost-transplantation within one year were 32.65%，16.94% and 26.92%，respectively（group B vs. group C ：χ2 ＝ 4.30，P ＜ 0.05）. The proportion of DGF in the three groups was 25.17%，12.42% and 17.9%，respectively. The durations of DGF in each group were （14.86±6.15）d，（15.63±4.56）d and（13.7±4.24）d，respectively. There were no significant differences among three groups. The serum creatinine（SCr）levels of patients with DGF one month after transplantation was（223.39±129.18）μmol/L，（225.62±182.97）μmol/L，（170.76±50.30）μmol/L，respectively. The incidence of bone marrow suppression one year after surgery was 8.8%（13/147），6.8%（12/177），2.6%（2/78）. There were no statistically significant differences among groups. The prevalence of pulmonary infection in each group was 11.56%，7.9%，2.6%，respectively. The incidence rate of group A was higher than that of group C（P ＜ 0.05）. The incidence of CMV infection in both groups A and group B were higher than that in group C（P ＜ 0.01）. Conclusion Both T-cell polyclonal antibodies and basiliximab can be safely and effectively used in the induction therapy of DDkidneytransplantation. Compared with basiliximab，T-cell polyclonal antibodies can increase the risk of pneumonia and CMV infection. 

Key words:

Kidney transplantation, Immune induction, Acute rejection, Delayed graft function after kidney transplantation, Infection

摘要：

目的 对比分析 T 细胞多克隆抗体和巴利昔单抗在公民逝世后器官捐献（deceased donation，DD）肾移植中应用的有效性和安全性。方法 本研究为回顾性、单中心、对照研究。回顾性分析自 2015 年8 月 20 日至 2020 年 2 月 28 日昆明市第一人民医院符合纳入标准的 402 例成人肾移植受者的临床资料，依据其免疫诱导方案将其分为兔抗人胸腺细胞免疫球蛋白（rabbit anti human thymocyte immunoglobulin，rATG）组（A 组），抗人 T 细胞兔免疫球蛋白（anti-human T lymphocyte rabbit immunoglobulin，ATG-F）组（B 组）和巴利昔单抗组（C 组），主要结局包括三组患者的急性排斥反应（acute rejection，AR）发生情况、移植物功能延迟恢复（delayed graft function，DGF）的累计发生率。次要结局指标包括肺部感染、骨髓抑制、巨细胞病毒（cytomegalovirus，CMV）感染的发生率。 结果 A 组、B 组、C 组在术后 1 年内 AR 累计发生率分别为32.65%、16.94%、26.92%，其中 B 组较 C 组发生率低（χ2 ＝ 4.30，P ＜ 0.05）。三组患者 DGF 发生率分别为25.17%（37/147）、12.42%（22/177）、17.9%（14/78）。三组 DGF 持续时间分别为（14.86±6.15）d、（15.63±4.56）d、（13.7±4.24）d，组间无显著差异。发生 DGF 患者术后 1 个月血清肌酐（serum creatinine，SCr）分别为（223.39±129.18）μmol/L、（225.62±182.97）μmol/L、（170.76±50.30）μmol/L，A 组与 C 组相比，差异具有统计学意义（t ＝ 2.6789，P ＜ 0.05）。术后 1 年内骨髓抑制累计发生率分别为 8.8%、6.8% 及 2.6%，组间无显著性差异。肺部感染累计发生率分别为 11.56%、7.9% 及 2.6%，A 组发生率高于 C 组（P ＜ 0.05）。A、B 两组CMV 感染累计发生率均高于 C 组（P ＜ 0.01）。 结论 rATG 和 ATG-F 与巴利昔单抗作为 DD 肾移植术早期排斥反应的预防均显示安全、有效。与巴利昔单抗相比，T 细胞多克隆抗体增加肺部感染及 CMV 感染风险。 

关键词:

肾移植 , 免疫诱导 , 急性排斥反应 , 移植肾功能延迟恢复 , 感染