背景：有移植肾功能延迟恢复（DGF）和免疫排斥肾移植患者很多采用兔抗胸腺细胞球蛋白（rATG）进行诱导。我们研究的目的在于明确常规接受rATG诱导的肾移植受者DGF相关的危险因素及其结果。方法：我们回顾性地分析了我们关于处理大多数接受新型免疫抑制治疗的高危患者的经验。结果：在231个尸体肾移植患者中，高危的因素包括非洲裔美国种族（68%）、再次移植（12%）、峰值PRA水平至少高于20%（19%）、扩大标准供肾（15%）以及冷缺血时间超过24小时（27%）。有29%的患者出现DGF。DGF的患者rATG为7.3mg/kg，而非DGF的患者为5 mg/kg(P<0.0001)。DGF的危险因素包括体重指数超过30 kg/m(2) ([OR]=1.5, P=0.02)、女性供者男性受者配对(OR=1.5, P=0.033)、使用西罗莫司(OR=1.7, P=0.003)、以及供者肌酐水平高于1.5 mg/dL (OR=1.6, P=0.016)。两组1年患者生存率(99% 非DGF, 91% DGF; P=0.001)以及36个月内排斥反应发生率(11% 非DGF, 22.4% DGF; P=0.025)不同。移植后第二和第三年DGF的患者其排斥反应的发生率更高。36个月内的排除死亡移植肾存活率相似。结论：肾移植患者常规采用rATG诱导后的DGF与性别、供者肌酐水平以及免疫抑制治疗方案相关。虽然1年内的排斥反应发生率较低，DGF依然和患者低生存率相关。重要的是1年后发生过DGF的患者依然有发生排斥反应的危险。供受者的选择会影响近期的结果，但是若不对基线时免疫抑制治疗方案进行调整，从长期来看采用诱导治疗并无优势。

BACKGROUND: Induction rabbit antithymocyte globulin (rATG) is largely used in renal allograft recipients at risk for delayed graft function (DGF) and immunologic rejection. The purpose of our study was to characterize risk factors and outcomes associated with DGF when it occurs in recipients undergoing routine rATG induction. METHODS: We retrospectively reviewed our experience in a predominantly high-risk population receiving modern immunosuppressive regimens. RESULTS: Of 231 deceased-donor transplants, high-risk characteristics included African American race (68%), retransplants (12%), peak panel reactive antibody of atleast 20% (19%), expanded criteria donor kidney (15%), and cold ischemia time exceeding 24 hr (27%). DGF occurred in 29% of patients. rATG was continued to a dose of 7.3 mg/kg in DGF patients and 5 mg/kg in non-DGF patients (P<0.0001). Risk factors for DGF were recipient body mass index greater than 30 kg/m(2) (odds ratio [OR]=1.5, P=0.02), female donor/male recipient pairings (OR=1.5, P=0.033), sirolimus use (OR=1.7, P=0.003), and donor creatinine more than 1.5 mg/dL (OR=1.6, P=0.016). One-year patient survival (99% non-DGF, 91% DGF; P=0.001) and acute rejection incidence through 36 months (11% non-DGF, 22.4% DGF; P=0.025) differed between groups. DGF patients experienced a higher rejection rate during the second and third years posttransplant. Death-censored graft survival was similar throughout 36 months. CONCLUSION: In kidney transplantation with routine rATG induction, DGF was related to size and gender, donor creatinine, and immunosuppressive protocol. Despite low first-year rejection rates, DGF was associated with inferior patient survival. Importantly, patients with DGF continued to be at risk for rejection beyond the first year. Donor and recipient selection impacts short-term outcomes, and induction alone may not confer a long-term advantage without further modification of baseline therapy.