Mazimba Sula, Tallaj Jose A, George James F, Kirklin James K, Brown Robert N, Pamboukian Salpy V
Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Transplant. 2014 Sep;28(9):946-52. doi: 10.1111/ctr.12395. Epub 2014 Jul 25.
Data from Cardiac Transplant Research Database (CTRD) were analyzed from 1999 to 2006 to examine the effects of different induction strategies at the time of cardiac transplantation. A total of 2090 primary heart transplants were categorized by induction with interleukin-2 receptor blocker (IL-2RB), antithymocyte globulin (ATG), or no induction (NI). Probabilities for rejection and infection were estimated with parametric time-related models. Using these models, hazard was calculated for two theoretical patient profiles, one at lower risk for rejection and higher risk of infection (Profile 1) and higher risk for rejection and lower risk of infection (Profile 2). Of the 2090 transplants, 49.8% (1095) did not receive induction, 27.3% (599) received IL-2RB, and 18.0% (396) received ATG. Profile 1 patients had lower hazard for rejection with IL-2RB compared to ATG and NI (p < 0.01), but at the cost of increased risk of infection (5.0 vs. 1.8 vs. 1.6, respectively, at four wk, p < 0.01). Profile 2 patients experienced a fivefold decreased hazard for rejection when treated with IL-2RB compared with ATG and NI (p < 0.01). In patients at high risk of infection, IL-2RB reduced risk of rejection but at the expense of increased hazard for infection.
对心脏移植研究数据库（CTRD）1999年至2006年的数据进行分析，以研究心脏移植时不同诱导策略的效果。共有2090例初次心脏移植根据是否使用白细胞介素-2受体阻滞剂（IL-2RB）、抗胸腺细胞球蛋白（ATG）诱导或不进行诱导（NI）进行分类。采用参数化时间相关模型估计排斥反应和感染的概率。使用这些模型，计算了两种理论患者情况的风险，一种是排斥反应风险较低但感染风险较高（情况1），另一种是排斥反应风险较高但感染风险较低（情况2）。在2090例移植中，49.8%（1095例）未接受诱导，27.3%（599例）接受IL-2RB，18.0%（396例）接受ATG。情况1的患者使用IL-2RB时排斥反应风险低于使用ATG和NI（p<0.01），但代价是感染风险增加（四周时分别为5.0、1.8和1.6，p<0.01）。与ATG和NI相比，情况2的患者使用IL-2RB治疗时排斥反应风险降低了五倍（p<0.01）。在感染风险高的患者中，IL-2RB降低了排斥反应风险，但以增加感染风险为代价。
