心肺联合移植的诱导免疫抑制

Induction immunosuppression for combined heart-lung transplantation.

作者信息

Hayes Don, McConnell Patrick I, Yates Andrew R, Tobias Joseph D, Galantowicz Mark, Mansour Heidi M, Tumin Dmitry

机构信息

Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.

Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.

出版信息

Clin Transplant. 2016 Oct;30(10):1332-1339. doi: 10.1111/ctr.12827. Epub 2016 Sep 7.

DOI:10.1111/ctr.12827

PMID:27490992

Abstract

BACKGROUND

Research on induction immunosuppression in patients undergoing combined heart-lung transplantation (HLTx) is limited.

METHODS

The United Network for Organ Sharing database was queried from 2000 to 2013 to examine the influence of induction immunosuppression for combined HLTx in adult (≥18 years) and adolescent (≥12 and <18 years) recipients.

RESULTS

Of 394 eligible combined HLTx cases (361 adults, 33 adolescents), 384 were included in univariate Cox analysis and 116 in the multivariate Cox model. Univariate analysis demonstrated no differences in survival by induction medication and no difference among the most common maintenance immunosuppression regimens. Adjusting for use of corticosteroids, multivariate analysis demonstrated no benefit of basiliximab (HR=3.582; 95% CI: 0.966, 13.279; P=.056), thymoglobulin/antilymphocyte globulin (ALG)/antithymocyte globulin (ATG) (HR=0.808; 95% CI: 0.134, 4.888; P=.817), alemtuzumab (HR=0.369; 95% CI: 0.087, 1.563; P=.176), or other induction medications (HR=1.511; 95% CI: 0.146, 15.610; P=.729), compared to no induction medication, with respect to mortality hazard post-HLTx. There were also no differences in treated acute rejection episodes by type of induction immunosuppression.

CONCLUSIONS

Induction immunosuppression with contemporary agents does not improve survival after combined HLTx.

摘要

背景

关于心肺联合移植（HLTx）患者诱导免疫抑制的研究有限。

方法

查询器官共享联合网络数据库2000年至2013年的数据，以研究诱导免疫抑制对成年（≥18岁）和青少年（≥12岁且<18岁）心肺联合移植受者的影响。

结果

在394例符合条件的心肺联合移植病例中（361例成人，33例青少年），384例纳入单因素Cox分析，116例纳入多因素Cox模型。单因素分析显示，诱导用药对生存率无差异，最常见的维持免疫抑制方案之间也无差异。在调整皮质类固醇使用情况后，多因素分析显示，与未使用诱导药物相比，巴利昔单抗（HR = 3.582；95%CI：0.966，13.279；P = 0.056）、兔抗人胸腺细胞免疫球蛋白/抗淋巴细胞球蛋白（ALG）/抗胸腺细胞球蛋白（ATG）（HR = 0.808；95%CI：0.134，4.888；P = 0.817）、阿仑单抗（HR = 0.369；95%CI：0.087，1.563；P = 0.176）或其他诱导药物（HR = 1.511；95%CI：0.146，15.610；P = 0.729）在心肺联合移植术后死亡风险方面并无益处。诱导免疫抑制类型在治疗急性排斥反应发作方面也无差异。