Efficacy and safety of single high-dose versus multiple low-dose ATG-Fresenius induction in de novo renal transplantation
10.3760/cma.j.issn.0254-1785.2017.11.006
- VernacularTitle:ATG-F单次大剂量与多次低剂量给药应用于肾移植诱导治疗的有效性和安全性
- Author:
Liping CHEN
1
;
Chunbai MO
;
Jun TIAN
;
Guanghui PAN
;
Changxi WANG
;
Jianghua CHEN
;
Tao LIN
;
Xiaodong ZHANG
;
Yaowen FU
;
Long LIU
;
Zhishui CHEN
;
Aimin ZHANG
;
Minzhuan LIN
;
Xuyong SUN
;
Jinsong CHEN
;
Hang LIU
;
Shaoling ZHENG
;
Tongyu ZHU
;
Qingshan QU
;
Bingyi SHI
Author Information
1. 中国人民解放军第三○九医院器官移植研究所
- Keywords:
Kidney transplantation;
Anti-T-lymphocyte globulin;
Induction treatment
- From:
Chinese Journal of Organ Transplantation
2017;38(11):665-670
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the efficacy and safety of single bolus high dose (SD group) ATG-Fresenius induction therapy in kidney transplantation vs.multiple low dose (MD group) administration.Methods A multiple center,prospective,randomized and controlled clinical study was performed on 280 de novo renal transplant recipients from 19 centers.Patients were randomized into 2 groups as follows:SD group,a single high dose (7-9 mg/kg) of ATG-F infused as an induction agent before the vessel anastomoses;MD group,2 mg/kg of ATG-F daily administrated in postoperative 4 days.All the patients accepted maintenance immunosuppressive protocol including tacrolimus,mycophenolate and prednisone.Patients were assessed and data were collected at regular schedule clinic visits on the day 1,3,7,14,30,90,180,270 and 365.The primary end point of efficacy was therapeutic failure rate [the number of death,grafts loss and acute rejection (AR)].The event first occurred should be used in the classification of patients.The non-inferiority evaluation of the two treatment regimens was done based on treatment failure rate.The secondary end points of efficacy were the incidence of AR,delayed graft function (DGF),1-year survival rate of patients and grafts,and serum creatinine at each visiting point.The indicators for safety evaluation included hemotologic variation and incidence of adverse events.Results The therapeutic failure rate in SD group was non-inferior to the MD group (17.24％ vs.23.08％).AR was the major cause of therapeutic failure and there was similar incidence of AR between SD gronp and MD group (12.07％ vs.21.37％).There was no significant difference in the incidence of DGF between SD group and MD group (12.07％ vs.6.84％,P =0.1721).The 1-year patient's survival rate and 1-year graft survival rate in SD group and MD group showed no significant difference (96.55％ vs.98.29％,P =0.6714;94.83％ vs 98.29％,P =0.2750).The serum creatinine level showed no significant differences between two groups at each visit point.There was also no significant difference in total incidence of adverse events between the two groups.In addition,there was also no statistically significant difference in the incidence of concerned and drug-related adverse events between the two groups,including infection,hemotologic abnormality,liver or renal dysfunction,gastrointestinal disorder,etc.After ATG--F administration,peripheral blood lymphocytes in the SD and the MD group immediately decreased but nearly restored to the normal level on the postoperative day 30 and 90 respectively.No severe granulocytopenia,erythropenia or thrombocytopenia occurred in both two groups.Conclusion The efficacy and safety of single high dose of ATG-F induction are non-inferior to multiple low dose ATG-F induction,moreover,single high dose of ATG-F induction is administered more conveniently and economically.
