| Objective:Renal transplantation is the best treatment to improve the survival rate and quality of life of patients with end-stage renal disease.In an environment where kidney organs are relatively scarce,donation after cardiac death(DCD)and expanded standard donation(ECD)increased significantly,while the incidence of delayed graft function(DGF)is still at a high level.Immunosuppressants can not only reduce the incidence of DGF,but also reduce the negative effects related to rejection after DGF,which is helpful to the recovery of renal allograft function.At present,immune induction therapy has achieved good results in renal transplantation.antithymocyte globulin(ATG)and Basiliximab are the most commonly used polyclonal and monoclonal antibodies,but which is better is controversial.Therefore,the purpose of this study was to compare the efficacy and safety of ATG and Basiliximab induction therapy in patients with DGF after dead donor transplantation(DDKT).Methods:91 patients with DGF after DDKT were collected from the Transplantation Center of Jiangxi Provincial people’s Hospital and first affiliated Hospital of Nanchang University from January 1,2020,to December 31,2021.They were divided into two groups according to the induction therapy:group 1(n=37)received ATG and group 2(n=54)received Basiliximab.The recipients were followed up for12 months,and the basic demographic data and related clinical data of the two groups were collected.The observation indexes included the recovery time of DGF,the incidence of AR,mortality and graft failure rate,serum creatinine(Cr)and estimated glomerular filtration rate(e GFR)1,3,6 and 12 months after operation and the incidence of pulmonary infection,urinary tract infection,skin infection,cytomegalovirus(CMV)infection,tuberculosis infection,fungal infection,leukopenia,thrombocytopenia,new-onset diabetes mellitus and malignant tumor.SPSS 25.0 was used to evaluate the difference between continuous variables of non-normal distribution and normal distribution by Mann-Whitney U test and Independent Samples t-test,and the classified variables were analyzed using Chi-square test or Fisher exact test.Results:The baseline of donors and patients was basically the same between the two groups,without statistical significance.There was no significant difference in the recovery time of DGF(median 24.5 days vs.18 days,P=0.078),the incidence of AR(29.7%vs.29.6%,P=0.992),the mortality rate(P=1)and the failure rate of renal transplantation(P=0.266)between the ATG group and the Basiliximab group.The levels of serum Cr at 1 month(median 232 mmol/L vs.173.8 mmol/L,P=0.006)and3 months(median 160 mmol/L vs.134.9 mmol/L,P=0.01)after operation in Basiliximab group were lower than ATG group.One month after operation,the level of e GFR(median 30.8 m L/min/1.73?m~2vs.36.3 m L/min/1.73?m~2,P=0.022)in Basiliximab group was higher than that in ATG group.There was no significant difference in serum Cr and e GFR at other time points.The rate of ATG induction therapy was higher in DGF delayed recovery group(31%vs.54.8%,P=0.027).The incidence of thrombocytopenia in ATG group was higher than that in Basiliximab group(59.5%vs.33.3%,P=0.014)but there was no significant difference in the incidence of pulmonary infection,urinary tract infection,skin infection,CMV infection,tuberculosis infection,fungal infection,leukopenia,new-onset diabetes mellitus and malignant tumor.Conclusion:In this study,the efficacy and safety of ATG and Basiliximab induction therapy in DDKT patients with DGF are similar,which can reduce the adverse factors related to rejection,promote the recovery of renal allograft function,and improve the survival rate of renal allografts and patients.In DGF population,there was no significant difference in recovery time of DGF,incidence of AR,mortality and renal allograft failure,infection,leukopenia,new-onset diabetes and malignant tumor between Basiliximab and ATG.Basiliximab had more advantages in incidence of thrombocytopenia and early recovery of renal function. |
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