Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.
J Heart Lung Transplant. 2011 Jul;30(7):770-7. doi: 10.1016/j.healun.2011.01.716. Epub 2011 Mar 27.
Induction therapy with antithymocyte globulin (ATG) after heart transplantation (HTx) has never been assessed in a placebo-controlled randomized trial. We investigated trends in use of ATG and its relationship to outcome after HTx in a national cohort.
Between July 1995 and March 2008, 2,151 adult HTxs were performed. Patients given OKT3 or an interleukin-2 receptor antagonist, repeat transplants, heterotopic, and multi-organ transplants were excluded, leaving 2,086 HTx for analysis. Of these, 1,143 (55%) received induction with ATG.
The proportion of patients given ATG increased from 26% in June 1995 to 75% in August 2007 (p < 0.01). The age and gender distributions of recipients and donors were similar in the ATG and non-ATG groups. Survival to 10 years was similar: 56.2% in the non-ATG group vs 55.9% in the ATG group (p = 0.95). The number of treated rejection episodes in the first year was lower in the ATG group (incidence rate ratio, 0.76; 95% confidence interval [CI], 0.68-0.85, p < 0.01), but the number of infective episodes was higher (incidence rate ratio, 1.18; 95% CI, 1.00-1.39, p = 0.048), and these differences remained after risk adjustment, with an adjusted incidence rate ratio of 0.85 (95% CI, 0.75-0.95, p < 0.01) and 1.21 (95% CI, 1.02-1.44; p = 0.027). Deaths due to infective causes were higher in the ATG group (p = 0.03).
There has been a trend towards an increased use of induction therapy. There was no change in overall survival, but ATG induction was associated with a decreased incidence of rejection and an increase in infection.
在心脏移植（HTx）后，抗胸腺细胞球蛋白（ATG）诱导治疗从未在安慰剂对照的随机试验中进行评估。我们在一个全国性队列中研究了 ATG 的使用趋势及其与 HTx 后结果的关系。
1995 年 7 月至 2008 年 3 月期间，进行了 2151 例成人 HTx。排除了接受 OKT3 或白细胞介素-2 受体拮抗剂、重复移植、异位和多器官移植的患者，剩下 2086 例 HTx 进行分析。其中，1143 例（55%）接受了 ATG 诱导。
接受 ATG 治疗的患者比例从 1995 年 6 月的 26%增加到 2007 年 8 月的 75%（p < 0.01）。ATG 组和非 ATG 组的受体和供体的年龄和性别分布相似。10 年生存率相似：非 ATG 组为 56.2%，ATG 组为 55.9%（p = 0.95）。在第一年，ATG 组治疗的排斥反应发作次数较少（发病率比，0.76；95%置信区间 [CI]，0.68-0.85，p < 0.01），但感染发作次数较多（发病率比，1.18；95% CI，1.00-1.39，p = 0.048），并且在风险调整后仍然存在这些差异，调整后的发病率比为 0.85（95% CI，0.75-0.95，p < 0.01）和 1.21（95% CI，1.02-1.44；p = 0.027）。ATG 组因感染导致的死亡更高（p = 0.03）。
诱导治疗的使用呈上升趋势。总生存率没有变化，但 ATG 诱导与排斥反应发生率降低和感染发生率增加有关。
