Comparison Of ATG And Simulect In Kidney Transplantation:Retrospective Analysis And Meta-analysis

ObjectiveIn recent years,the incidence of chronic kidney disease is increasing annually,which has become one of the major concerns of the medical and health services all over the world.Nowadays,kidney transplantation has become the most effective method to solve end-stage renal disease.Long-term survival of the transplanted kidney and the patient's immune tolerance are the major goals of the transplant community.A variety of factors impact on the short-term and long-term survival of the transplanted kidney.At present,there are about more than 100,000 new patients of end-stage renal disease in China,but less than 10,000 recipients can receive a kidney transplant every year.Therefore,how to make good use of the limited donor resources,ensure the quality of transplantation,and improve the safety of transplantation is the main problem facing to the transplant community.Nowadays,it has become a consensus in the field of transplantation that induction therapy can be used before transplantation.Appropriate immuno-induction therapy can not only reduce the rejection rate,improve the short-term survival rate of grafts,but also reduce the occurrence of DGF.However,there is no consensus on the selection of immune induce types.On the other hand,the incidence of various infections has increased after the application of immunosuppressive agents.Therefore,this study analyzed the clinical data of kidney transplantation patients treated with immune inducers in the department of urology of Qianfoshan hospital affiliated to Shandong university,and discussed the effects and adverse consequences of two immune inducers,Simulect and anti-thymocyte globulin(ATG),used in kidney transplantation from DCD sources.MethodsClinical data of patients receiving allogeneic kidney transplantation from January 2015 to June 2017 in Qianfoshan hospital affiliated to Shandong university were selected.Group A was the ATG induction therapy group,with 122 patients.Group B was the Simulect induction treatment group,with a 123 cases.To investigate the safety and efficacy of two kinds of immune inducers after kidney transplantation.At the same time,relevant meta-analysis was conducted according to the results of retrospective analysis,and summarized the results of retrospective analysis and meta-analysis.After comprehensive analysis,the effects and adverse consequences of the two inducers after kidney transplantation were further clarified.ResultsThis retrospective study included 245 patients with renal transplantation,postoperative follow-up time was 12 months.122 cases in group A,66 males and 56 female,including 3 kidney allograft loss cases,25 delayed graft function,,?13 BPAR,34 cases bacterial infection occurred,cytomegalovirus infection in 69 cases,leukopenia of 37 cases,33 thrombopenia,22 cases of new diabetes and 5 new malignant tumor.There were 123 cases in group B,2 kidney allograft loss cases,27 delayed graft function,,13 BPAR,27 cases bacterial infection occurred,cytomegalovirus infection in 45 cases,leukopenia of 23 cases,27 thrombopenia,17 cases of new diabetes and 2 new malignant tumor.The chi-square method was used to calculate the relevant clinical data,and it was found that there was no significant difference between the two inducers in graft kidney failure,delayed recovery of renal function,BRAP,bacterial infection,thrombocytopenia,new-onset diabetes and new malignant tumor.Simulect was superior than ATG in incidence about CMV infection and leukopenia.In the meta-analysis,10 studies including 1,849 subjects were included.The results showed that Simulect was superior to ATG in terms of CMV infection,leukopenia and thrombocytopenia,while there was no significant difference in other aspects.In addition,no publication bias was found in the 10 included studies.Conclusion1.There was no significant difference between ATG and Simulect in loss of graft function,delayed recovery of graft function,acute rejection,bacterial infection,new diabetes mellitus and new malignant tumor.However,sulai has advantages in reducing the incidence of cytomegalovirus infection,leukopenia and thrombocytopenia.2.ATG and Simulect on the safety and efficacy of renal transplantation were similar in general.Simulect has strong specificity and only acts on CD25 with few side effects and postoperative complications.ATG can inhibit T lymphocytes through multiple pathways and antigens,thereby reducing renal ischemia reperfusion injury,and thus having greater advantages in improving early renal recovery.3.The application of immune induction preparation should be based on the specific conditions of kidney transplant patients and should be considered in many synthesized aspects.