Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD.
Transplantation. 2020 Jun;104(6):1294-1303. doi: 10.1097/TP.0000000000002959.
Hepatitis C virus-positive (HCV+) kidney transplant (KT) recipients are at increased risks of rejection and graft failure. The optimal induction agent for this population remains controversial, particularly regarding concerns that antithymocyte globulin (ATG) might increase HCV-related complications.
Using Scientific Registry of Transplant Recipients and Medicare claims data, we studied 6780 HCV+ and 139 681 HCV- KT recipients in 1999-2016 who received ATG or interleukin-2 receptor antagonist (IL2RA) for induction. We first examined the association of recipient HCV status with receiving ATG (versus IL2RA) using multilevel logistic regression. Then, we studied the association of ATG (versus IL2RA) with KT outcomes (rejection, graft failure, and death) and hepatic complications (liver transplant registration and cirrhosis) among HCV+ recipients using logistic and Cox regression.
HCV+ recipients were less likely to receive ATG than HCV- recipients (living donor, adjusted odds ratio [aOR] = 0.640.770.91; deceased donor, aOR = 0.710.810.92). In contrast, HCV+ recipients who received ATG were at lower risk of acute rejection compared to those who received IL2RA (1-y crude incidence = 11.6% versus 12.6%; aOR = 0.680.820.99). There was no significant difference in the risks of graft failure (adjusted hazard ratio [aHR] = 0.861.001.17), death (aHR = 0.850.951.07), liver transplant registration (aHR = 0.580.971.61), and cirrhosis (aHR = 0.730.921.16).
Our findings suggest that ATG, as compared to IL2RA, may lower the risk of acute rejection without increasing hepatic complications in HCV+ KT recipients. Given the higher rates of acute rejection in this population, ATG appears to be safe and reasonable for HCV+ recipients.
丙型肝炎病毒阳性（HCV+）的肾移植（KT）受者发生排斥反应和移植物失功的风险增加。对于这一人群，最佳诱导剂仍存在争议，特别是抗胸腺细胞球蛋白（ATG）可能增加 HCV 相关并发症的担忧。
我们使用 Scientific Registry of Transplant Recipients 和 Medicare 理赔数据，研究了 1999 年至 2016 年间 6780 名 HCV+和 139681 名 HCV-的 KT 受者，他们接受了 ATG 或白细胞介素-2 受体拮抗剂（IL2RA）诱导。首先，我们使用多水平逻辑回归分析了受者 HCV 状态与接受 ATG（与 IL2RA 相比）的相关性。然后，我们使用逻辑回归和 Cox 回归研究了 ATG（与 IL2RA 相比）与 HCV+受者的 KT 结局（排斥反应、移植物失功和死亡）和肝脏并发症（肝移植登记和肝硬化）之间的相关性。
与 HCV-受者相比，HCV+受者接受 ATG 的可能性较低（活体供者，调整后的优势比 [aOR] = 0.640.770.91；已故供者，aOR = 0.710.810.92）。相反，与接受 IL2RA 的患者相比，接受 ATG 的 HCV+受者发生急性排斥反应的风险较低（1 年的总发生率为 11.6%与 12.6%；aOR = 0.680.820.99）。在移植物失功（调整后的危险比 [aHR] = 0.861.001.17）、死亡（aHR = 0.850.951.07）、肝移植登记（aHR = 0.580.971.61）和肝硬化（aHR = 0.730.921.16）的风险方面，两组之间无显著差异。
与 IL2RA 相比，我们的研究结果表明，ATG 可能会降低 HCV+KT 受者急性排斥反应的风险，而不会增加肝脏并发症。鉴于该人群急性排斥反应的发生率较高，ATG 似乎对 HCV+受者是安全且合理的。
