Document Detail


Preoperative single-bolus high-dose antithymocyte globulin as induction therapy in sensitized renal transplant recipients.
MedLine Citation:
PMID:  17097014     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Immunological sensitization remains a major problem following renal transplantation. There is no consensus for the management of sensitized renal allograft recipients. The patients become tethered to dialysis while waiting for compatible donors. This study was designed to evaluate the efficacy and safety of preoperative single-bolus high-dose antithymocyte globulin (ATG) as induction therapy in sensitized renal transplant recipients. METHODS: A total of 56 patients were divided into two groups according to the level of panel reactive antibody (PRA): non-sensitized group (PRA < 10%, n = 30) and sensitized group (PRA > or = 10%, n = 26). The characteristics of the recipients and donors were comparable between the two groups. Mycophenolate mofetil (MMF, 1 g) or ATG (iv. 9 mg/kg) were given preoperatively in the two groups as induction therapy. After the transplantation, the patients were treated with standard triple therapy regimen consisting of tacrolimus (FK-506) or cyclosporine A, MMF, and prednisolone. Acute rejection (AR) and infection episodes were recorded and renal function was monitored during a 12-month follow-up. Chi(2) test and t test were used to analyze the data. RESULTS: During the follow-up, 6 patients (20.0%) suffered AR episodes in the non-sensitized group and 4 (15.4%) in the sensitized group (P = 0.737); 8 patients (26.7%) experienced 11 infection episodes (average, 1.4 episodes per infected patient) in the non-sensitized group, and 6 (23.1%) experienced 10 infection episodes (average, 1.7 episodes per infected patient) in the sensitized group (P = 0.757, 0.890). The safety of the drugs, which was assessed by the occurrence of side effects, was comparable between the two groups. The hospital stay was 13 - 25 days (mean, 16.7 +/- 3.3) in the non-sensitized group and 14 - 29 days (mean, 16.2 +/- 3.1) in the sensitized group, respectively (P = 0.563). No delayed graft function (DGF) was observed in all the patients. Both the 12-month actuarial patient and graft survival rates were 100% in the two groups. CONCLUSION: Preoperative single-bolus high-dose ATG is an effective and safe induction therapy yielding acceptable acute rejection rate in sensitized renal transplant recipients.
Authors:
Dong Wang; Wei-zhen Wu; Shun-liang Yang; Jin-hua Chen; Jian-ming Tan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chinese medical journal     Volume:  119     ISSN:  0366-6999     ISO Abbreviation:  Chin. Med. J.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-11-13     Completed Date:  2006-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513795     Medline TA:  Chin Med J (Engl)     Country:  China    
Other Details:
Languages:  eng     Pagination:  1683-8     Citation Subset:  IM    
Affiliation:
Department of Urology, Fuzhou General Hospital of PLA, Fuzhou 350025, China.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antilymphocyte Serum / adverse effects,  therapeutic use*
Female
Graft Rejection / prevention & control
Graft Survival
Humans
Immunosuppressive Agents
Kidney Transplantation*
Male
Middle Aged
Chemical
Reg. No./Substance:
0/Antilymphocyte Serum; 0/Immunosuppressive Agents

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