Yakubu Idris, Ravichandran Bharath, Sparkes Tracy, Barth Rolf N, Haririan Abdolreza, Masters Brian
Pharmacy, 21668University of Maryland Medical Center, Baltimore, MD, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Pharm Pract. 2021 Apr;34(2):199-206. doi: 10.1177/0897190019850934. Epub 2019 Jul 17.
The optimal choice of induction immunosuppression for elderly kidney transplant recipients remains unclear. Although alemtuzumab has been associated with escalating risk of death and graft loss in this population, this risk has not been adequately explored. The purpose of this study was to compare the safety and efficacy of alemtuzumab with basiliximab induction in this population.
This is a retrospective matched cohort study of kidney transplant recipients aged ≥65 years. Patients who received alemtuzumab induction were matched (1:2) to a basiliximab control. The primary outcome was allograft survival. The incidence of acute rejection, infection, and all-cause mortality was measured.
Fifty-one and 102 patients were included in the alemtuzumab and basiliximab groups, respectively. Baseline demographics were similar between groups, except for more living donor transplant recipients in the alemtuzumab group (26/51 [51%] vs 31/102 [30.4%], = .02). Acute cellular rejection occurred more frequently within the first year in the basiliximab group ( = .02). There was no difference in rates of infection within the first year. Graft and patient survival rates were similar over the follow-up period. Patients receiving basiliximab had a higher glomerular filtration rate at 2 years posttransplant (59 mL/min/1.73 m vs 49 mL/min/1.73 m, = .03).
Alemtuzumab induction is associated with similar outcomes to basiliximab in elderly kidney transplant recipients.
老年肾移植受者诱导免疫抑制的最佳选择仍不明确。尽管阿仑单抗与该人群中死亡和移植物丢失风险的增加相关，但这一风险尚未得到充分研究。本研究的目的是比较阿仑单抗与巴利昔单抗在该人群中的安全性和有效性。
这是一项对年龄≥65岁的肾移植受者进行的回顾性匹配队列研究。接受阿仑单抗诱导的患者与巴利昔单抗对照组进行1:2匹配。主要结局是移植肾存活。测量急性排斥反应、感染和全因死亡率的发生率。
阿仑单抗组和巴利昔单抗组分别纳入51例和102例患者。除阿仑单抗组活体供肾移植受者更多外（26/51 [51%] 对31/102 [30.4%]，P = 0.02），两组基线人口统计学特征相似。巴利昔单抗组在第一年急性细胞排斥反应更频繁发生（P = 0.02）。第一年感染率无差异。随访期间移植肾和患者存活率相似。接受巴利昔单抗的患者在移植后2年肾小球滤过率更高（59 mL/min/1.73 m²对49 mL/min/1.73 m²，P = 0.03）。
在老年肾移植受者中，阿仑单抗诱导与巴利昔单抗的结局相似。
