胰肾联合移植中的诱导治疗：兔抗人胸腺细胞免疫球蛋白与巴利昔单抗对比

Induction therapy in simultaneous pancreas-kidney transplantation: thymoglobulin versus basiliximab.

作者信息

Fernández-Burgos I, Montiel Casado M C, Pérez-Daga J A, Aranda-Narváez J M, Sánchez-Pérez B, León-Díaz F J, Cabello-Díaz M, Rodríguez-Burgos D, Hernández-Marrero D, Santoyo-Santoyo J

机构信息

Department of Digestive Surgery and Transplantation, Hospital Regional Universitario de Málaga, Málaga, Spain.

出版信息

Transplant Proc. 2015 Jan-Feb;47(1):120-2. doi: 10.1016/j.transproceed.2014.12.003.

DOI:10.1016/j.transproceed.2014.12.003

PMID:25645787

Abstract

BACKGROUND

Induction therapy for simultaneous pancreas-kidney (SPK) transplantation. Both thymoglobulin (ATG) and basiliximab are the most-used types of induction antibodies therapies in clinical practice. The aim of our report was to analyze our experience comparing 2 induction therapies, for SPK transplantation in terms of pancreas and patient survival, as well as rejection rate.

METHODS

We reviewed retrospectively a total of 97 SPK transplantations in our institution. The cases were divided according to induction therapy in 2 groups, basiliximab (n = 38) and ATG (n = 59). Rejection, patient and graft survival, and postoperative complications were analyzed.

RESULTS

Survival in the ATG group was better without statistical difference at 1-, 3-, and 5-year follow-up (97%, 95%, and 95% versus 92%, 90%, and 87%, respectively). No difference was detected in pancreas graft survival after 1-, 3-, and 5-year follow-up (basiliximab 85%, 80%, and 77% versus ATG 84%, 84%, and 81%, respectively; log-rank, 0.847). Overall cellular rejection and early rejection were more common in the basiliximab group (30 versus 14%, and 21% versus 6%). In the multivariate analysis considering human leukocyte antigen (HLA) mismatches, the ATG group was a protective factor for cellular rejection. Major complications (Grade III-IV) and median length of the hospital stay were higher in the basiliximab group (55% versus 34%, P = .057, and 21 versus 16 days, P = .056).

CONCLUSIONS

The pancreas graft survival was not affected by induction therapy. ATG induction therapy compared with basiliximab is associated with lower overall and early rejection rate. Over time this difference disappears.

摘要

背景

同期胰肾联合移植（SPK）的诱导治疗。在临床实践中，抗胸腺细胞球蛋白（ATG）和巴利昔单抗都是最常用的诱导抗体治疗类型。我们报告的目的是分析我们在比较两种诱导治疗对SPK移植的胰腺和患者生存率以及排斥率方面的经验。

方法

我们回顾性分析了本机构共97例SPK移植病例。根据诱导治疗将病例分为两组，巴利昔单抗组（n = 38）和ATG组（n = 59）。分析排斥反应、患者和移植物生存率以及术后并发症。

结果

在1年、3年和5年随访时，ATG组的生存率更好，但无统计学差异（分别为97%、95%和95%，对比92%、90%和87%）。在1年、3年和5年随访后，胰腺移植物生存率未发现差异（巴利昔单抗组分别为85%、80%和77%，ATG组分别为84%、84%和81%；对数秩检验，0.847）。巴利昔单抗组总体细胞排斥反应和早期排斥反应更为常见（分别为30%对14%，21%对6%）。在考虑人类白细胞抗原（HLA）错配的多变量分析中，ATG组是细胞排斥反应的保护因素。巴利昔单抗组的主要并发症（III-IV级）和中位住院时间更高（分别为55%对34%，P = 0.057；21天对16天，P = 0.056）。