Chinese guideline for clinical application of antithymocyte globulin in liver transplant recipients

doi:10.3877/cma.j.issn.1674-3903.2024.06.003

Abstract

Abstract:

Liver transplantation is the most effective treatment for end-stage liver diseases.Although the liver has a unique immunological microenvironment, resulting in significantly lower incidence and severity of rejection after liver transplantation than other solid organ transplantation,rejection remains common, with incidence of 15%-25%.Antithymocyte globulin (ATG) is a concentrated anti-human T-lymphocyte immunoglobulin preparation, which is used in the immunosuppressive induction therapy for the organ transplantation to improve the survival rate of graft and recipient.The Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association organized experts to discuss, summarize the latest progress of relevant research at home and abroad, and elaborate the mechanism, clinical application scenarios and precautions of ATG in combination with international guidelines and clinical practice, aiming to provide guidance and suggestions for clinical application of ATG in liver transplant recipients.

Key words: Liver transplantation, Rejection, Immunosuppressant, Antithymocyte globulin, Immunosuppressive induction therapy

Transplantation Group, Branch of Organ Transplantation of Chinese Liver, of Organ Transplant Physicians of Chinese Branch. Chinese guideline for clinical application of antithymocyte globulin in liver transplant recipients[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(06): 346-354.

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References 80

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推荐意见	证据级别	描述
A	1a	基于RCT 的系统评价(有同质性)
	1b	单个RCT 研究
	1c	“全或无”证据(有治疗以前,所有患者都死亡;有治疗之后,有患者能存活。或者在有治疗之前,一些患者死亡;有治疗之后,无患者死亡)
B	2a	基于队列研究的系统评价(有同质性)
	2b	单个队列研究(包括低质量RCT,如<80%随访)
	3a	基于病例对照研究的系统评价(有同质性)
	3b	单个病例对照研究
C	4	病例报道(低质量队列研究)
D	5	专家意见或评论

推荐意见	证据级别	描述
A	1a	基于RCT 的系统评价(有同质性)
	1b	单个RCT 研究
	1c	“全或无”证据(有治疗以前,所有患者都死亡;有治疗之后,有患者能存活。或者在有治疗之前,一些患者死亡;有治疗之后,无患者死亡)
B	2a	基于队列研究的系统评价(有同质性)
	2b	单个队列研究(包括低质量RCT,如<80%随访)
	3a	基于病例对照研究的系统评价(有同质性)
	3b	单个病例对照研究
C	4	病例报道(低质量队列研究)
D	5	专家意见或评论

类型	危险因素
供者相关	脂肪变性供肝;高龄供者供肝;小体积供肝;ABO 血型不相容供肝;心脏死亡器官捐献供者供肝;经历长冷缺血时间的供肝等
受者相关	女性受者;年轻受者;二次肝移植受者;HLA 配型错误;手术时间延长;既往接受免疫检查点抑制剂等肿瘤免疫治疗;受者高致敏状态,群体反应性抗体阳性; 伴发或合并以下基础疾病:慢性肝衰竭、原发性胆汁性肝硬化、丙型肝炎、心血管疾病、自身免疫性肝病、肝肾综合征(术前)、肾功能不全(术后)等

类型	危险因素
供者相关	脂肪变性供肝;高龄供者供肝;小体积供肝;ABO 血型不相容供肝;心脏死亡器官捐献供者供肝;经历长冷缺血时间的供肝等
受者相关	女性受者;年轻受者;二次肝移植受者;HLA 配型错误;手术时间延长;既往接受免疫检查点抑制剂等肿瘤免疫治疗;受者高致敏状态,群体反应性抗体阳性; 伴发或合并以下基础疾病:慢性肝衰竭、原发性胆汁性肝硬化、丙型肝炎、心血管疾病、自身免疫性肝病、肝肾综合征(术前)、肾功能不全(术后)等

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