背景：ATG是免疫高危肾移植受者诱导治疗的选择之一。但是，尚未对该亚组患者其最佳的剂量进行研究。方法：为了评估rATG总的剂量对于这些患者的移植效果，我们对96名包含再次移植（85%）或PRA超过40%（15%）的患者进行回顾性队列研究，这些患者采用他克莫司、霉酚酸酯以及激素维持。组1(n=33)接受7.5 mg/kg的ATG，组2接受超过7.5 mg/kg的ATG，比较移植物和患者生存率、急性排斥反应发生率和12个月时血肌酐值(SCr)。结果：两组在人口参数统计、供者资源、再移植、PRA以及HLA错配方面相当。组2有更多的非洲裔美国人(44.4%比21.2%, P=0.03)。在25.4+/-18.0的随访期内，两组患者生存率分别为82.5% 和79.4%(P=0.54)。组1中3名患者和组2中4名患者死亡(P=0.65)。两组间最初12个月的活检证实的急性排斥反应无明显差异（分别为9.5%和8.8%, P=0.9）。12个月时的Scr水平组1为1.6+/-0.7、组2为1.8+/-1.0(P=0.3)。在rATG剂量和移植物生存率间（组2比组1的风险比: 0.85, P=0.79, 95% CI: 0.26-2.7）、或者和1年的血肌酐水平间(回归系数=0.02 for ln(SCr), P=0.3; 95%CI: -0.01 to 0.6)无独立的联系。结论：我们的结果提示高危的肾移植受者总ATG剂量低于或者等于7.5 mg/kg相比于更高的剂量其所得的低排斥反应发生率及移植物生存率相当，因此是安全有效。

BACKGOUND.: Thymoglobulin (rATG) has become the agent of choice for induction therapy in high immunological risk kidney transplant recipients. However, its optimal dosing in this subgroup has not been studied. METHODS.: To evaluate the effect of total rATG dosing on graft outcomes in such patients, we conducted a retrospective cohort study of 96 adult patients who received repeat transplants (85%) or had panel reactive antibody more than 40% (15%) and were maintained on tacrolimus, mycophenolate mofetil, and steroid. Group 1 (n=33) received less than or equal to 7.5 and group 2 (n=63) received more than 7.5 mg/kg rATG. Graft and patient survival, incidence of acute rejection (AR), and 12-month serum creatinine (SCr) were examined. RESULTS.: The groups were comparable regarding demographics, donor source, retransplantation, panel reactive antibody, and human leukocyte antigen mismatch. Group 2 had more African Americans (44.4% vs. 21.2%, P=0.03). During the 25.4+/-18.0 months follow-up graft survival was 82.5% and 79.4%, respectively (P=0.54). Three in group 1 and four in group 2 died (P=0.65). The incidence of biopsy proven AR during the first 12-months did not differ between the groups (9.5% vs. 8.8%, respectively, P=0.9). SCr at 12 months was 1.6+/-0.7 in group 1 and 1.8+/-1.0 in group 2 (P=0.3). There was no independent association between rATG dose and graft survival (hazard ratio: 0.85, P=0.79, 95% CI: 0.26-2.7 for group 2 vs. 1) or 1-year SCr (regression coefficient=0.02 for ln(SCr), P=0.3; 95%CI: -0.01 to 0.6). CONCLUSION.: Our results suggest that in high risk kidney transplant recipients total rATG doses less than or equal to 7.5 mg/kg are safe and effective in achieving a low rate of AR and graft outcomes comparable to higher doses.