Centre de Recherche en Transplantation et Immunologie INSERM UMR1064, Université de Nantes, RTRS "Centaure", Nantes, France.
Department of Nephrology and Transplantation, Hôpital Hôtel Dieu, Nantes, France.
Transplantation. 2020 Mar;104(3):613-622. doi: 10.1097/TP.0000000000002804.
In nonimmunized patients, similar rejection rates are observed for patients who have undergone thymoglobulin (antithymocyte globulins [ATG]) or basiliximab (BSX) therapy. While ATG may improve delayed graft function, it may also be associated with higher infection rates and malignancy risk. We compared survival and clinical outcomes in elderly recipients with low immunological risk according to their induction therapy.
We conducted a multicentric study on nonimmunized patients ≥65 years of age receiving a first kidney transplant between 2010 and 2017. The principal outcome was patient and graft survival. Secondary outcomes were cumulative probabilities of infection, first acute rejection episode, malignancy, de novo donor specific antibody, posttransplant diabetes (PTD), cardiac complications, estimated glomerular filtration rate, and occurrence of delayed graft function. Cox, logistic, or linear statistical models were used depending on the outcome studied, and models were weighted on the propensity scores.
Two hundred and four patients were included in the BSX group and 179 in the ATG group with the average age of 71.0 and 70.5 years, respectively. Patient and graft survival at 3 years posttransplantation were 74% (95% CI, 65%-84%) and 68% (95% CI, 60%-78%) in ATG and BSX group, respectively, without significant difference. Occurrence of PTD was significatively higher in BSX group (23% versus 15%, P = 0.04) due to higher trough levels of Tacrolimus on month 3 (9.48 versus 7.30 ng/mL, P = 0.023). There was no difference in other evaluated outcomes.
In elderly recipients, ATG does not lead to poorer outcomes compared with BSX and could permit lower trough levels of Tacrolimus, thus reducing occurrence of PTD.
在未免疫的患者中，接受胸腺球蛋白（抗胸腺细胞球蛋白 [ATG]）或巴利昔单抗（BSX）治疗的患者的排斥反应率相似。虽然 ATG 可能改善延迟移植物功能，但它也可能与更高的感染率和恶性肿瘤风险相关。我们根据诱导治疗比较了低免疫风险老年受者的生存和临床结局。
我们进行了一项多中心研究，纳入了 2010 年至 2017 年间接受首次肾移植的年龄≥65 岁的非免疫患者。主要结局是患者和移植物的生存。次要结局是感染、首次急性排斥反应、恶性肿瘤、新的供体特异性抗体、移植后糖尿病（PTD）、心脏并发症、估算肾小球滤过率和延迟移植物功能的累积发生率。根据研究的结果，使用 Cox、逻辑或线性统计模型，并对倾向评分进行加权。
BSX 组纳入 204 例患者，ATG 组纳入 179 例患者，平均年龄分别为 71.0 岁和 70.5 岁。移植后 3 年患者和移植物的存活率分别为 ATG 组 74%（95%CI，65%-84%）和 BSX 组 68%（95%CI，60%-78%），无显著差异。BSX 组 PTD 的发生率明显更高（23%比 15%，P=0.04），这是由于 Tacrolimus 在第 3 个月的谷浓度更高（9.48 比 7.30ng/mL，P=0.023）。其他评估结果无差异。
在老年受者中，与 BSX 相比，ATG 不会导致较差的结局，并且可能允许 Tacrolimus 的谷浓度更低，从而降低 PTD 的发生率。
