A Review of the Evidence for Use of Thymoglobulin Induction in Renal Transplantation

被引:33
作者
Gaber, A. Osama [1 ,2 ]
Knight, R. J. [1 ]
Patel, S. [3 ]
Gaber, L. W. [4 ]
机构
[1] Methodist Hosp, Dept Surg, Methodist Transplant Ctr, Houston, TX 77030 USA
[2] Weill Cornell Med Coll, New York, NY USA
[3] Methodist Hosp, Dept Pharm, Houston, TX 77030 USA
[4] Methodist Hosp, Dept Pathol, Houston, TX 77030 USA
关键词
RECEIVING MYCOPHENOLATE-MOFETIL; ANTI-IL-2 RECEPTOR ANTIBODIES; ANTITHYMOCYTE GLOBULIN; IMMUNOSUPPRESSIVE THERAPY; KIDNEY-TRANSPLANTATION; BASILIXIMAB INDUCTION; CYCLOSPORINE-A; FOLLOW-UP; RECIPIENTS; DACLIZUMAB;
D O I
10.1016/j.transproceed.2010.04.019
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Depleting antilymphocyte, or antithymocyte antibodies, have long been an integral part of induction regimens and continue today to be used in the management of patients at risk of early rejection or those in whom the introduction of calcineurins or other immune suppressants must be delayed. Registry data demonstrate that the most commonly used depleting antibody, rabbit anti-human thymocyte globulin (rATG), is associated with improved outcomes following renal transplantation in high-risk patients, particularly in conjunction with steroid-avoidance regimens. Two prospective randomized trials in high-risk renal allograft patients have also demonstrated an advantage of r-ATG induction compared to the nondepleting interleukin receptor (IL2RA) antibodies. In low-immunologic-risk patients, however, r-ATG induction and IL2RA induction appear to be equivalent in terms of rejection prophylaxis and long-term function. Other studies have shown that sequential rATG-containing regimens were superior to no induction and allowed for successful late introduction of calcineurin inhibitors. The side effect profile of the depleting antibody included increased incidence of fever, hematologic abnormalities, cytomegalovirus infections when prophylaxis was not employed, and in some studies, increased incidence of posttransplant lymphoproliferative disease. This review describes the evidence supporting the use of depleting ATGs in kidney transplantation.
引用
收藏
页码:1395 / 1400
页数:6
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