| Objective: All kinds of chronic renal lesions might develop into chronic renal insufficiency and even uremia at the later stage, In the past years the incidence of uremia has been increasing. Dialysis ,hemodialysis in particular,is still the major treatment of uremia at present,but renal transplantation shows the tendency of increasing with each passing year, and is considered as the essential method to cure chronic renal failure.The special tolerance and long-term survival rate of renal and patient is our goal.Many factors can have influence on the renal and patient ,including delayed graft functin . Delayed graft functin is a form of acute renal failure that results in post-transplantation oliguria.Many factors can cause DGF,such as donor and recipient and preservation methords,and so on.Ischaemic/reperfusion is a very important factor.Many straegies are used to prevent ischaemic/reperfusion injury and delayed graft functin,such as antioxidants, vasodilatory drugs , anti-inflammatory drugs , immunosuppressive drugs , improvement preservation solution. Immunosuppressive drugs are very important in them.Every immunosuppressive regimen has some effect.Monoclonal antibodies and polyclonal antibodies are uesd widely in DGF patients.they often utilized as rescue therapy or induction therapy.Also ,patients with delayed graft function,more prone to CyA toxicity and AR,are trated with antilymphocyte globulins. The aim of each type of induction therpy is to provide efficient immunosuppression without severe infection,to minimize early graft dysfunction,and to delay the occurrence and to decrease theincidence of steroid-resistant acute rejections.These are important points because it is generally accepted that delayed graft function and rejection mainly infuluence graft survival.From an immunologic point of view,polyclonal antibodies ,which react with many epitopes seem to offer a good strategy for induction therpy.ATG is polyclonal antibody from rabbit or horse. It is a kind of powerful immunosuppressant, ATG has a highly antibodies activities against the T-cell receptor constant areaCD3,CD8;against the lymophocyte markers CD2,CD4,and CD7;against the activation marker CD71;and against molecules involved in adhesion and proliferation (CD1 la,CD54).Activities to such a wide variety of CD antigens in these polyclonal agents could mean that in addition to the broad lymphocyte-depleting effect of ATG antibodies,antibody specifities for molecules involved in lymphocyte adhension and activation contribute to the exceptional effectiveness of ATG as an immnunosuppressive agent.But how to ueses these antibodies every center has his own opinion. The effect, the opportunity, the dose of the drug, all of these need further exploration and discussion.We had uesd two-dose regimen of ATG in the patients of renal transplantation,the aim of our study was to evaluate the efficacy and the safety of ATG induction therpy.Methods: 70 adult cadaveric renal transplant patients were enrolled in this study, they were received homograft renal transplantation in our hospital from May -2001 to Oct-2004.Patients with a panel-reactive antibody below 10%,have a first transplantation, and all the donors were the brain dead persons who were aged from 22 to 42.A11 the patients and donors have the same blood type.Patients were devided into two groups regarding the ATG induction therpy. Group A and Group B received triple therapy with prednisone , mycophenolate mofetil (MMF)/ Azathiopurine (Aza) ,and tacrolimus/ Cyclosporine (CsA) . All patients received methylprednision 1000 mg on day 0 and 500 mg on day 1 and 2.1n the same time, Group A received ATG(lmg/kg) induction therapy the day of operation and the second day after operation. Dexamethasone of 5mg was injected intravenous before ATG.Group B didn1 t received ATG induction therapy. Monitor T lymphocyte subset and concentration of drug in blood to adjust the dosage of FK506/ CsA.Compare Group A and Group B the survival and the death rate of person and renal, the incidence of AR,the incidence of DGF ,the intensity of DGF,the side effect of medication, etc, and evaluate the efficacy and the safety of ATG induction therpy.Results: Observe for 6 months. And during the 6 months, no patient died both Group A and Group B. The surviving rate of person in Group A and Group B of 6 months after operation are 100%.p>0.05. The survival rate of graft in the two groups of 6 months after operation arel00%.p>0.05. There are 1 cases of DGF in Group A ,and the incidence of DGF is 3.3%; There are 8 cases of DGF in Group B ,and the incidence of DGF is 20.0%.Patients in Group A recovered from DGF were 13 days, Patients in Group B recovered from DGF were 16, 15, 27, 16, 19,18,22,15 days respectively, p>0.05.Scr in Gtoup A decresed down to normal was 3 + 1.5 days, Scr in Gtoup B decresed down to normal was 4+0.8 days, p<0.05. The concentration of FK506 on 7th and 28th day were 13 + 3ng/ml, 12 + 3.2ng/ml respectively in Group A;The concentration of FK506 on 7th and 28th day were 12 + 3.4ng/ml, 12.4 + 2.3ng/ml respectively in Group B, p>0.05.and so does the concentration of CsA.The T lymphocyte subset in Group A on 7th day were CD3 15.03±5.43,CD4 6.84+4.91,CD8 8.16 +7.23,CD4/CD8 0.7+0.8;The T lymphocyte subset in Group B on 7th day were CD3 49.45 + 8.92,CD4 29.46+ 6.87,CD8 21.20±6.87,CD4/CD8 1.28 +1.47, p<0.05. T lymphocyte subset in Group A on 28th day were CD3 49.90 + 12.64,CD4 35.04 + 10.82,CD8 14.86 + 9.64,CD4/CD8 1.28 ± 0.50,The T lymphocyte subset in Group B on 28th day were CD3 60.42 +17.89,CD4 34.49+ 11.59,CD8 25.71 + 14.47,CD4/CD8 1.68 + 1.14, p<0.05.The lymphocyte and lymphocyte ratio were significant in the two groups on 7th day and 28th day respectively, p<0.05.Adverse events of paitients in Group A, including 3 cases of fever, 1 case of dyspnea,2 case of tachycardia,2 case of vomiting,4 case of local pain,no seurm sickness happened, 8 case of infection of respiratory and urinary,all of mild or moderate severity. 3 case of lymphopenia, 6 case of leucopenia,5 case of thrombopenia;Adverse events of paitients in Group B, including 1 cases of fever, 1 case of tachycardia, 2 case of vomiting, no seurm sickness happened ,7 case of infection of respiratory and urinary,all of mild or moderate severity. 5 case of leucopenia ,2 case of lymphopenia,3 case of thrombopenia .There were no differencein adverse events between the two groups except local pain.Conclusion: 1. Delayed graft function has a high frequency in renal transplantation. Many factors can lead to delayed graft function and it has a important influenace to the short-term and long-term survival rate of graft;2. As the therapeutic medicine to DGF, two-dose regimen of ATG can decrease the frequency of DGF. In this report, the rate of DGF is 3.3%.It can rescue some of patients from losing graft as a result of DGF;3. As a kind of foreign protein, ATG can lead to many side efects such as fever, dyspnea and vomitus ,but it dose not lead to initial dose syndrome or grave consequences such as acute pneumonedema after entering the body, However attention should be aroused. |
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