Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Transplantation. 2012 Mar 15;93(5):493-502. doi: 10.1097/TP.0b013e3182427fc3.
We aimed to investigate the impact of antibody induction on outcomes in human leukocyte antigen (HLA) 0-mismatched deceased donor kidney recipients.
Using the Organ Procurement and Transplant Network/United Network of Organ Sharing database as of November 2009, we identified 44,008 adult deceased donor kidney recipients who received primary kidney transplants alone between 2003 and 2008 (HLA 0 mismatch, n = 6274; ≥ 1 mismatch, n=37,734; median follow-up: 834 days). The impact of induction (thymoglobulin, interleukin-2 receptor antagonists [IL-2RA], or alemtuzumab; vs. no induction) on rejection (initial hospitalization, 6 months, first year), death-censored graft failure, and mortality were analyzed using multivariate logistic and Cox regression in the two groups. The impact of individual agents on outcomes was further analyzed in 0-mismatch recipients.
There was a decreased risk of rejection over the first 6 months for HLA 0-mismatch recipients of antibody induction (adjusted odds ratio=0.71, P=0.003), but this effect was not observed at 1 year; in comparison, induction was associated with a reduced risk of rejection over the first year for HLA-mismatched recipients (0.87, P<0.001). The use of thymoglobulin (0.72, P=0.02) and IL-2RA (0.67, P=0.004) was associated with a decreased risk of rejection compared with no-induction at 6 months but was not different at 1 year (thymoglobulin: 0.77, P=0.05; IL-2RA:0.81, P=0.11) in HLA 0-mismatched recipients. Induction was not associated with improved graft or patient survival in HLA 0-mismatch recipients.
In HLA 0-mismatch deceased donor recipients, antibody induction was associated with a decreased risk of rejection at 6 months posttransplant. Its use did not improve graft and patient survival over the follow-up period.
本研究旨在探讨抗体诱导治疗对人类白细胞抗原（HLA）0 错配的尸体供肾受者结局的影响。
利用截至 2009 年 11 月的器官获取与移植网络/联合器官共享网络数据库，我们共纳入 2003 年至 2008 年间接受单纯尸体供肾移植的 44008 例成年受者（HLA 0 错配，n=6274；≥1 错配，n=37734；中位随访时间：834 天）。采用多变量逻辑回归和 Cox 回归分析诱导治疗（胸腺球蛋白、白细胞介素-2 受体拮抗剂[IL-2RA]或阿仑单抗；vs. 无诱导治疗）对两组受者移植后 6 个月内（初始住院期间、6 个月、第 1 年）排斥反应（排斥反应发生率、死亡相关移植物丢失和死亡率）的影响。进一步分析 0 错配受者中不同抗体诱导药物对结局的影响。
HLA 0 错配受者接受抗体诱导治疗后 6 个月内排斥反应风险降低（校正比值比=0.71，P=0.003），但该作用在第 1 年未观察到；相比之下，HLA 错配受者接受诱导治疗后第 1 年排斥反应风险降低（0.87，P<0.001）。与无诱导治疗相比，HLA 0 错配受者在第 6 个月时使用胸腺球蛋白（0.72，P=0.02）和 IL-2RA（0.67，P=0.004）可降低排斥反应风险，但在第 1 年时无差异（胸腺球蛋白：0.77，P=0.05；IL-2RA：0.81，P=0.11）。HLA 0 错配受者中，诱导治疗与移植物和患者存活率的改善无关。
在 HLA 0 错配的尸体供肾受者中，移植后 6 个月时使用抗体诱导治疗可降低排斥反应风险。但在随访期间，诱导治疗并未改善移植物和患者的存活率。
