Martin Spencer T, Kato Tomoko S, Farr Maryjane, McKeen Jaclyn T, Cheema Faisal, Ji Mengxi, Ross Alexandra, Yerebakan Halit, Naka Yoshifumi, Takayama Hiroo, Restaino Susan, Mancini Donna, Schulze P Christian
Department of Pharmacy, Hartford Hospital, Hartford, CT (S.T.M.), USA; Heart Center, Juntendo University School of Medicine, Tokyo (T.S.K.), Japan; Department of Medicine, Division of Cardiology (T.S.K., M.F., M.J., A.R., S.R., D.M., P.C.S.), Department of Surgery, Division of Cardiothoracic Surgery (F.C., H.Y., Y.N., H.T.), Columbia University Medical Center, New York, NY; and Department of Pharmacy, Hackensack Medical Center, Hackensack, NJ (J.T.M.), USA.
Circ J. 2015;79(2):368-374. doi: 10.1253/circj.CJ-14-0718. Epub 2014 Dec 12.
Induction therapy with interleukin-2 receptor antagonists has been established as an effective immunosuppressive strategy in the management of heart transplant (HTx) recipients. We compared outcomes following HTx in patients receiving basiliximab, daclizumab, or no induction therapy.
We investigated post-transplant prognosis of patients receiving basiliximab (n=67), daclizumab (n=98) or no induction therapy (n=70). Patients treated with daclizumab (50.3 ± 14.7 years) were younger than those receiving basiliximab (55.8 ± 11.2 years) or no induction therapy (54.9 ± 14.1 years; both P<0.05). Patients receiving either induction therapy showed better survival 1 year after HTx (95%) than those without induction therapy (82%; P<0.001). Survival was similar between patients receiving basiliximab and daclizumab. The incidence of acute cellular or antibody-mediated rejections did not differ among the groups. The main reason that patients did not receive induction therapy was ongoing infection (65.7%), which was more common in patients on ventricular assist device (VAD) support than those without VAD (76.1% vs. 45.8%; P=0.004). The VAD-related infection rate in the entire study cohort was 29.7% (35/118 VAD recipients).
Survival following HTx was worse in patients not receiving induction therapy. No differences were noted in survival or the incidence of rejection between the daclizumab- and basiliximab-treated groups. Induction therapy was less used in patients with infection, which was related to prior VAD support.
白细胞介素-2受体拮抗剂诱导治疗已被确立为心脏移植（HTx）受者管理中的一种有效免疫抑制策略。我们比较了接受巴利昔单抗、达利珠单抗或不进行诱导治疗的HTx患者的结局。
我们调查了接受巴利昔单抗（n = 67）、达利珠单抗（n = 98）或不进行诱导治疗（n = 70）的患者的移植后预后。接受达利珠单抗治疗的患者（50.3±14.7岁）比接受巴利昔单抗治疗的患者（55.8±11.2岁）或不进行诱导治疗的患者（54.9±14.1岁）年轻（均P<0.05）。接受任何一种诱导治疗的患者在HTx后1年的生存率（95%）均高于未接受诱导治疗的患者（82%；P<0.001）。接受巴利昔单抗和达利珠单抗治疗的患者生存率相似。各组急性细胞性或抗体介导的排斥反应发生率无差异。患者未接受诱导治疗的主要原因是持续感染（65.7%），这在接受心室辅助装置（VAD）支持的患者中比未接受VAD支持的患者更常见（76.1%对4
