Hachem Ramsey R, Edwards Leah B, Yusen Roger D, Chakinala Murali M, Alexander Patterson G, Trulock Elbert P
Division of Pulmonary & Critical Care, Washington University School of Medicine, St. Louis, MO, USA.
Clin Transplant. 2008 Sep-Oct;22(5):603-8. doi: 10.1111/j.1399-0012.2008.00831.x. Epub 2008 Apr 23.
The use of induction immunosuppression after lung transplantation remains controversial. In this study, we examined the impact of induction on survival after lung transplantation.
We performed a retrospective cohort study of 3970 adult lung transplant recipients reported to the ISHLT Registry. We divided the cohort into three groups based on the use of induction: none, interleukin-2 receptor antagonists (IL-2 RA), and polyclonal antithymocyte globulins (ATG). We estimated graft survival using the Kaplan-Meier method and constructed a multivariable Cox proportional hazards model to examine the impact of induction on graft survival in the context of other variables.
During the study period, 2249 patients received no induction, 1124 received IL-2 RA, and 597 received ATG. Four years after transplantation, recipients treated with IL-2 RA had better graft survival (64%) than those treated with ATG (60%) and those who did not receive induction (57%; log rank p = 0.0067). This survival advantage persisted in the multivariable model for single and bilateral recipients treated with IL-2 RA compared to those who did not receive induction (RR = 0.82, p = 0.007). Similarly, bilateral recipients treated with ATG had a survival advantage over bilateral recipients who did not receive induction (RR = 0.78, p = 0.043), but single lung recipients treated with ATG did not have a survival advantage over single lung recipients who did not receive induction (RR = 1.06, p = 0.58).
Induction with lL-2 RA for single and bilateral lung recipients and induction with ATG for bilateral recipients are associated with a survival benefit, independent of other variables that might impact survival.
肺移植后诱导免疫抑制的使用仍存在争议。在本研究中，我们探讨了诱导治疗对肺移植后生存率的影响。
我们对向国际心脏和肺移植学会（ISHLT）登记处报告的3970例成年肺移植受者进行了一项回顾性队列研究。根据是否使用诱导治疗，我们将队列分为三组：未使用、白细胞介素-2受体拮抗剂（IL-2 RA）和多克隆抗胸腺细胞球蛋白（ATG）。我们使用Kaplan-Meier方法估计移植物生存率，并构建多变量Cox比例风险模型，以在其他变量的背景下研究诱导治疗对移植物生存率的影响。
在研究期间，2249例患者未接受诱导治疗，1124例接受IL-2 RA，597例接受ATG。移植后四年，接受IL-2 RA治疗的受者移植物生存率（64%）高于接受ATG治疗的受者（60%）和未接受诱导治疗的受者（57%；对数秩检验p = 0.0067）。与未接受诱导治疗的受者相比，在单肺和双肺受者的多变量模型中，接受IL-2 RA治疗的受者的这种生存优势依然存在（风险比[RR]=0.82，p = 0.007）。同样，接受ATG治疗的双肺受者比未接受诱导治疗的双肺受者有生存优势（RR = 0.78，p = 0.043），但接受ATG治疗的单肺受者与未接受诱导治疗的单肺受者相比没有生存优势（RR = 1.06，p = 0.58）。
单肺和双肺受者使用IL-2 RA进行诱导治疗以及双肺受者使用ATG进行诱导治疗与生存获益相关，独立于其他可能影响生存的变量。
