Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Heart Fail Rev. 2018 Sep;23(5):641-649. doi: 10.1007/s10741-018-9691-2.
Approximately 50% of heart transplant programs currently employ a strategy of induction therapy (IT) with either interleukin-2 receptor antagonists (IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early postoperative period. However, the overall utility of such therapy is uncertain and data comparing induction protocols are limited. The authors searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through January 2018 for randomized controlled trials (RCTs) or observational controlled studies of IT vs no IT and IL2RA vs ATG. Inverse variance fixed effects models with odds ratio (OR) as the effect measure were used for primary analyses. Main outcomes include moderate and severe rejection, all-cause mortality, infection, and cancer. The authors' search retrieved 2449 studies, of which 11 met criteria for inclusion (8 RCTs and 3 observational case-control studies). Quality of evidence for RCTs was moderate to high. Overall, patients receiving IT had similar risk of moderate-to-severe rejection, all-cause death, infection, and cancer with patients who did not receive IT. The use of IL2RA was associated with significantly higher risk of moderate-to-severe rejection than ATG (OR 3.4; 95% CI 1.4 to 8.1), but similar risk of death, infections, and cancer. The use of IT was not associated with any benefits or harms compared with no IT. Moderate-to-severe rejection may be reduced by ATG compared with IL2RA.
目前，大约有 50%的心脏移植项目在术后早期使用白细胞介素-2 受体拮抗剂 (IL2RA) 或多克隆抗胸腺细胞抗体 (ATG) 进行诱导治疗 (IT)。然而，这种治疗的总体效果尚不确定，且比较诱导方案的数据有限。作者检索了 PubMed、Cochrane 中心对照试验注册库和 ClinicalTrials.gov，截至 2018 年 1 月，检索到的随机对照试验 (RCT) 或观察性对照研究包括 IT 与非 IT、IL2RA 与 ATG 的比较。主要结局包括中度和重度排斥反应、全因死亡率、感染和癌症。作者的检索共检索到 2449 项研究，其中 11 项符合纳入标准 (8 项 RCT 和 3 项观察性病例对照研究)。RCT 的证据质量为中至高。总体而言，接受 IT 治疗的患者与未接受 IT 治疗的患者相比，中度至重度排斥反应、全因死亡、感染和癌症的风险相似。与 ATG 相比，使用 IL2RA 与中度至重度排斥反应的风险显著增加 (OR 3.4;95%CI 1.4 至 8.1)，但死亡、感染和癌症的风险相似。与无 IT 相比，使用 IT 并未带来任何益处或危害。与 IL2RA 相比，ATG 可能降低中度至重度排斥反应的风险。
