Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Transpl Int. 2013 Oct;26(10):1016-26. doi: 10.1111/tri.12167. Epub 2013 Aug 16.
Alemtuzumab (AZ) induction in hepatitis C-seropositive (HCV+) kidney transplant (KTX) recipients may negatively affect patient survival; however, available information is scant. Using US registry data from 2003 to 2010 of adult HCV+ deceased-donor KTXs (n = 4910), we examined outcomes by induction agent - AZ (n = 294), other T cell-depleting agents, (n = 2033; T cell), IL-2 receptor blockade (n = 1135; IL-2RAb), and no induction (n = 1448). On multivariate analysis, induction therapy was associated with significantly better overall patient survival with AZ [adjusted hazards ratio (aHR) 0.64, 95% confidence interval (CI) 0.45, 0.92], T cell (aHR 0.52, 95% CI 0.41, 0.65) or IL-2RAb (aHR 0.67, 95% CI 0.53, 0.87), compared to no induction. A significant protective effect was also seen with AZ (aHR 0.63, 95% CI 0.40, 0.99), T cell (aHR 0.62, 95% CI 0.49, 0.78), and IL2R-Ab (aHR 0.62, 95% CI 0.47, 0.82) in terms of death-censored graft survival relative to no induction. There were 88 HIV+/HCV+ coinfected recipients. Compared to noninduction, any induction (i.e. three induction groups combined) was associated with similar overall patient survival (P = 0.2255) on univariate analysis. Induction therapy with AZ, other T cell-depleting agents, or IL-2RAb in HCV+ KTX is associated with better patient and death-censored graft survival compared to noninduction. In HCV/HIV coinfected patients, induction is not contraindicated.
阿仑单抗（AZ）诱导治疗丙型肝炎病毒（HCV）阳性（HCV+）肾移植（KTX）受者可能会对患者的生存产生负面影响；然而，目前的信息还很少。我们使用了 2003 年至 2010 年美国成人 HCV+尸肾 KTX 登记数据（n=4910），通过诱导剂-阿仑单抗（n=294）、其他 T 细胞耗竭剂（n=2033；T 细胞）、白细胞介素-2 受体阻断剂（n=1135；IL-2RAb）和未诱导（n=1448），检查了结果。多变量分析显示，与未诱导相比，诱导治疗与 AZ [调整后的危害比（aHR）0.64，95%置信区间（CI）0.45，0.92]、T 细胞（aHR 0.52，95% CI 0.41，0.65）或 IL-2RAb（aHR 0.67，95% CI 0.53，0.87）的总体患者生存率显著提高。AZ（aHR 0.63，95% CI 0.40，0.99）、T 细胞（aHR 0.62，95% CI 0.49，0.78）和 IL2R-Ab（aHR 0.62，95% CI 0.47，0.82）在死亡相关移植物存活率方面也有显著的保护作用。有 88 例 HIV/HCV 共感染受者。与未诱导相比，任何诱导（即三组诱导剂合并）在单变量分析中与相似的总患者生存率（P=0.2255）相关。与未诱导相比，在 HCV+KTX 中使用 AZ、其他 T 细胞耗竭剂或 IL-2RAb 进行诱导治疗与更好的患者和死亡相关移植物存活率相关。在 HCV/HIV 共感染患者中，诱导治疗并非禁忌。
