Carlo Waldemar F, Bryant Roosevelt, Zafar Farhan
Division of Pediatric Cardiology, The University of Alabama at Birmingham, Birmingham, Alabama.
Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatr Transplant. 2019 May;23(3):e13366. doi: 10.1111/petr.13366. Epub 2019 Feb 8.
BACKGROUND/OBJECTIVE: The impact of induction therapy in pediatric heart transplantation has been uncertain. Given the risk of poor outcomes in black pediatric heart transplant recipients, we evaluated the effect on graft survival of ATG and BAS induction in black and non-black pediatric recipients.
This was a retrospective analysis of pediatric candidates (aged ≤18 years) who underwent heart transplantation from 2000 to 2016 identified from the UNOS database. Primary outcome was 10-year graft survival.
This study included 654 patients receiving BAS, 2385 patients receiving ATG, and 2425 receiving no induction. Ten-year survival was similar for the following groups: non-black BAS (57%), non-black ATG (66%), and black ATG (51%). The black BAS group had a 10-year graft survival of 39% which was inferior on pairwise comparison to the other groups (all P values < 0.001). On multivariate analysis, ATG was associated with decreased risk of graft failure when compared to no induction (HR 0.86, 95% CI 0.76-0.97, P = 0.011) and had an association approaching statistical significance when compared to BAS induction (0.84, 0.7-1.01, P = 0.069). This association was seen in black recipients in whom ATG was strongly associated with decreased risk of graft failure when compared to either no induction (0.65, 0.5-0.83, P = 0.001) or BAS (0.64, 0.46-0.89, P = 0.008) but was not seen in non-black recipients.
Black pediatric heart transplant recipients who received ATG induction had an improved long-term graft survival compared to those who received BAS induction or no induction.
背景/目的：诱导治疗在小儿心脏移植中的作用尚不确定。鉴于黑人小儿心脏移植受者出现不良结局的风险，我们评估了抗胸腺细胞球蛋白（ATG）和巴利昔单抗（BAS）诱导治疗对黑人和非黑人小儿心脏移植受者移植物存活的影响。
这是一项对2000年至2016年在器官共享联合网络（UNOS）数据库中确定的接受心脏移植的小儿候选者（年龄≤18岁）进行的回顾性分析。主要结局是10年移植物存活情况。
本研究纳入了654例接受BAS诱导治疗的患者、2385例接受ATG诱导治疗的患者以及2425例未接受诱导治疗的患者。以下几组的10年生存率相似：非黑人BAS组（57%）、非黑人ATG组（66%）和黑人ATG组（51%）。黑人BAS组的10年移植物存活率为39%，与其他组进行两两比较时均较低（所有P值<0.001）。多因素分析显示，与未接受诱导治疗相比，ATG与移植物失败风险降低相关（风险比[HR]0.86，95%置信区间[CI]0.76 - 0.97，P = 0.011），与BAS诱导治疗相比，其相关性接近统计学意义（0.84，0.7 - 1.01，P = 0.069）。在黑人受者中可见这种相关性，与未接受诱导治疗（0.65，0.5 - 0.83，P = 0.001）或BAS诱导治疗（0.64，0.46 - 0.89，P = 0.008）相比，ATG与移植物失败风险降低密切相关，但在非黑人受者中未观察到这种相关性。
与接受BAS诱导治疗或未接受诱导治疗的黑人小儿心脏移植受者相比，接受ATG诱导治疗的患者长期移植物存活情况有所改善。
