INSERM UMR 1246-SPHERE, Nantes University, Tours University, Nantes, France.
Centre Hospitalier Universitaire de Nantes, Nantes, France.
PLoS One. 2020 Oct 22;15(10):e0240929. doi: 10.1371/journal.pone.0240929. eCollection 2020.
There is extensive literature with comparisons between Anti-Thymocyte Globulin (ATG) and Basiliximab (BSX) as induction therapy in kidney transplant recipients. The purpose of our benchmarking study was to describe the consequences in terms of practices in 6 transplantation centers of a French prospective cohort.
We included adult patients who received a first or second kidney graft between 2013 and 2019 (n = 4157). We used logistic regressions to identify characteristics associated with the use of ATG or BSX.
Use of ATG between the centers ranged from 41% to 75%. We observed different factors associated with the treatment decision. Compared to a first transplant, performing a second graft was the only factor significantly associated with the choice of ATG in all centers. The AUC ranged from 0.67 to 0.91, indicating that the centers seemed to define their own rules. As a result, for patients with the same low immunological risk, the probability of receiving ATG varied from 7% to 36%. We stratified the analyses according to two periods, from 2013 to 2015 and from 2016 to 2019. A similar heterogeneity was observed, and in some cases ATG indications between the centers were inverted.
The heterogeneity of induction therapy practices did not decrease in France, even if the reated literature is prolific. This illustrates the necessity to improve the literature by using meta-analyses of recent studies stratified by graft and patient profiles.
有大量文献比较了抗胸腺细胞球蛋白（ATG）和巴利昔单抗（BSX）作为肾移植受者诱导治疗的效果。我们这项基准研究的目的是描述法国前瞻性队列的 6 个移植中心的实践结果。
我们纳入了 2013 年至 2019 年间接受首次或再次肾移植的成年患者（n=4157）。我们使用逻辑回归来确定与使用 ATG 或 BSX 相关的特征。
中心之间使用 ATG 的比例从 41%到 75%不等。我们观察到不同的因素与治疗决策相关。与首次移植相比，在所有中心中，进行第二次移植是唯一与 ATG 选择相关的因素。AUC 范围从 0.67 到 0.91，表明中心似乎制定了自己的规则。因此，对于具有相同低免疫风险的患者，接受 ATG 的概率从 7%到 36%不等。我们根据 2013 年至 2015 年和 2016 年至 2019 年两个时期进行了分层分析。观察到类似的异质性，并且在某些情况下，中心之间的 ATG 指征发生了反转。
即使相关文献丰富，法国诱导治疗实践的异质性并没有降低。这说明有必要通过对按移植物和患者特征分层的近期研究进行荟萃分析来改进文献。
