| Background Since the completion of the world’s first kidney transplant in 1954,kidney transplantation has become the most effective and routine treatment for end-stage renal disease.With the development of medical technology,the success rate of surgery has been very high.Kidney transplant surgery can achieve such rapid advancement results and deepening the understanding of transplant immunology.With the development of transplant surgery,various safe,effective and low-toxic immunosuppressants have been developed and widely used in clinical practice because The emergence of immunosuppressive agents made the true sense of organ transplantation possible,and greatly promoted the development of organ transplantation.At present,common immunosuppressive agents include: chemical immunosuppressants and biological immunosuppressants;chemical immunization preparations: 1.Anti-cell proliferation drugs,representing drugs such as azathioprine,mycophenolate mofetil,and imidazoribine,cyclophosphamide;2,adrenal glucocorticoids,on behalf of drugs such as: prednisone,prednisolone,hydrocortisone,etc.;three,calcineurin inhibitors,on behalf of drugs such as: cyclosporine,Tac Moss;four,rapamycin target molecule inhibitors,on behalf of drugs such as: sirolimus,everolimus;five,other immunosuppressive agents,on behalf of drugs such as:15-deoxyspermine,dihydro whey Acid dehydrogenase inhibitors-leflunomide,etc.;biological immunosuppressive agents-anti-lymphocyte antibodies: a polyclonal anti-lymphocyte antibody,representing drugs such as: anti-lymphocyte globulin,antithymocyte globulin;anti-lymphocyte Polyclonal antibodies such as globulin and anti-thymocyte globulin can interfere with cell-mediated immune responses,includinggraft rejection,sensitivity to tuberculin,and graft versus host response.Polyclonal antibodies can remove delayed type hypersensitivity reactions that have occurred.In particular,it has a good effect on the rejection which has not been reversed after the hormone shock treatment.Second,monoclonal lymphocyte antibodies: representative drugs such as basiliximab(Shulai),daclizumab(Suni);(3)other new monoclonal antibodies such as: Alan monoclonal antibody(Kappa Lilitox monoclonal antibody(Mervaic);compared to polyclonal antibodies,the advantage of monoclonal antibodies is that monoclonal antibodies are antibodies produced by hybridoma cells that target only a particular antigenic determinant.It has the characteristics of high purity,high specificity,uniform nature,and infinite repeatability,which avoids the disadvantages of different titers between batches of polyclonal antibodies [1].At present,the commonly used immune inducers are basiliximab(Shulai)and antithymocyte globulin [2];our hospital adopts preoperative administration of polyclonal antibody against human thymocyte rabbit immunoglobulin for immune induction,according to individual conditions.Postoperative selection of cyclosporine/ tacrolimus + mycophenolate mofetil(/mycophenolate enteric-coated tablets +hormone triple immunosuppressive regimen.Delayed recovery of transplanted kidney function after renal transplantation,acute rejection Post-operative complications and other conditions will seriously affect the survival rate of transplanted human/kidney,and long-term survival and immune tolerance of transplanted human/kidney have always been the goal pursued by transplant experts.Antibody immunization induction is clinically applied.With more than 30 years of history,with the continuous advancement of biological technology and the in-depth study of antibody immuno-inducing agents,a large number of animal experiments and studies at home and abroad have confirmed that the application of antibody-based biological immunity inducers before transplantation can effectively reduce the surgery.The incidence of post-acute rejection,but the choice of biological immune inducers and whether it can reduce post-transplant infections and other complications There has been no consensus yet.Objective To review the clinical data of organ donation for kidney and kidney transplant recipients after the death of citizens.To investigate the safety and efficacy of perioperative immune induction regimen for kidney transplantation based on anti-human thymocyte rabbit immunoglobulin(ATG-F).METHODS A retrospective analysis of 67 patients who underwent renal transplantation for organ donation after the death of citizens in the Urology Department of Baotou Steel Hospital,Inner Mongolia from January to February 2018,67 patients were followed up for 1 year.A total of 56 patients were included in the study,and the clinical data of these 56 patients were selected as the study subjects.According to whether or not to give immune induction therapy,they were divided into experimental group and control group,and the experimental group,a total of 30 cases,according to the recipient’s weight.The physical condition was given to the anti-human thymocyte rabbit immunoglobulin treatment,the control group,a total of26 cases,kidney transplant recipients who did not receive immunotherapy;the two groups of patients were combined with cyclosporine / tacrolimus +Mycophenolate/mycophenolate enteric-coated tablets + hormone triple immunosuppressive regimen and adjusted tacrolimus concentration or cyclosporine dose according to blood concentration.The clinical data were used to analyze the data of early postoperative acute rejection,delayed renal function recovery,renal non-function of primary kidney transplantation,infection,renal allograft,and receptor death.Results Of the 56 patients with renal transplantation,33 patients had normal renal function recovery after surgery,the proportion was 48.21%;22 cases in the experimental group,accounting for 39.28%;11 cases in the control group,accounting for 19.64%;a total of 10 Acute rejection occurred in a proportion of 17.85%;2 cases in the experimental group,accounting for 3.57%;8 cases in the control group,accounting for 14.28%;9 cases in delayed recovery of the transplanted kidney;the ratio was 16.07%: the experimental group was 6 Case;accounted for 10.71%,control group was 3 cases,accounting for 5.35%;a total of 4 patients died,1 in theexperimental group and 3 in the control group;the incidence of acute rejection in the experimental group was significantly lower than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in the incidence of delayed graft recovery between the two groups(P>0.05).The incidence of slow recovery of transplanted kidney in the two groups was different.There was no statistical significance(both P>0.05).The graft/kidney survival rate of the control group was significantly lower than that of the experimental group(P<0.05).The incidence of lung infection in the experimental group was slightly higher.In the control group,but the difference between the two groups was not statistically significant(all P>0.05)There was no significant difference in the incidence of postoperative myelosuppression between the two groups(both P>0.05).There was no significant difference in the incidence of urinary tract infection between the two groups of transplant recipients.P>0.05);There was no significant difference in the incidence of digestive tract reaction between the two groups(P>0.05).There was no significant difference in serum creatinine values ??between the two groups at 1month,3 months and 6 months after operation.(P>0.05);There was a statistically significant difference in serum creatinine value at 12 months after surgery(P<0.05).Conclusion Induction of ATG-F during perioperative period can significantly reduce the incidence of acute rejection after renal transplantation,but does not increase the incidence of complications such as postoperative infections,possibly due to the small sample size,in actual cases and The severity of the infection is sufficient to cause clinical attention.The human/kidney survival rate is high in the short term,and it has good safety and effectiveness. |
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