Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Complex Care Analytics, MHealth Fairview, Minneapolis, MN, USA.
Pediatr Transplant. 2021 Aug;25(5):e13925. doi: 10.1111/petr.13925. Epub 2020 Dec 17.
We examined the association between induction type and outcomes of live-donor pediatric kidney recipients on tacrolimus and mycophenolate maintenance.
We analyzed the SRTR standard analysis file to evaluate primary live-donor pediatric kidney recipients between 2000 and 2018. Recipients were grouped by induction type into three groups: alemtuzumab n = 289, anti-thymocyte n = 1197, and IL-2RA n = 1625. Kaplan-Meier curves were generated for recipient and death-censored graft survival. Predictors of recipient and allograft survival were examined using Cox proportional hazards models. Models were adjusted for age, sex, ethnicity, renal failure etiology, HLA-mismatches, transplant year, steroid maintenance, preemptive transplantation, payor type, and donor factors such as age, sex, and donor-recipient relationship. The transplant center was included as a random effect to account for inter-center variability.
Rejection rates at 6 months (Alemtuzumab 9.5% vs. r-ATG 5.7% vs. IL2-RA 5.3%; P: .023) and 12 months (Alemtuzumab 14.5% vs. r-ATG 10.8% vs. IL2-RA 9%; P: .028) were significantly higher in the alemtuzumab group. PTLD rate (Alemtuzumab 0.8% vs. r-ATG 2.2% vs. IL2-RA 1%; P: .028) was significantly higher in the anti-thymocyte group. In the multivariable models, induction type did not influence patient or death-censored graft survival within ten years post-transplant.
In this large cohort of standard immunological risk primary pediatric live-donor kidney recipients, as compared to IL-2RA, neither alemtuzumab nor anti-thymocyte globulin was associated with improved long-term graft or recipient survival. In the first year post-transplant, recipients of alemtuzumab induction had a higher rejection rate, while PTLD was more frequently observed in the anti-thymocyte recipients.
我们研究了在他克莫司和霉酚酸酯维持治疗中，活体供肾儿童受者诱导类型与结局的关系。
我们分析了 SRTR 标准分析文件，以评估 2000 年至 2018 年间的原发性活体供肾儿童受者。受者按诱导类型分为三组：阿仑单抗 n=289 例、抗胸腺细胞球蛋白 n=1197 例和 IL-2RA n=1625 例。生成受者和死亡相关移植物存活率的 Kaplan-Meier 曲线。使用 Cox 比例风险模型检查受者和移植物存活率的预测因素。模型调整了年龄、性别、种族、肾衰竭病因、HLA 错配、移植年份、类固醇维持、抢先移植、支付类型以及供者年龄、性别和供者-受者关系等因素。移植中心作为随机效应纳入，以解释中心间的变异性。
6 个月时（阿仑单抗 9.5% vs. r-ATG 5.7% vs. IL2-RA 5.3%；P：.023）和 12 个月时（阿仑单抗 14.5% vs. r-ATG 10.8% vs. IL2-RA 9%；P：.028）的排斥反应率在阿仑单抗组显著更高。PTLD 发生率（阿仑单抗 0.8% vs. r-ATG 2.2% vs. IL2-RA 1%；P：.028）在抗胸腺细胞组中显著更高。在多变量模型中，诱导类型在移植后 10 年内并未影响患者或死亡相关移植物的存活率。
在这个大型标准免疫风险原发性活体供肾儿童受者队列中，与 IL-2RA 相比，阿仑单抗和抗胸腺细胞球蛋白均与长期移植物和受者存活率的提高无关。在移植后第一年，阿仑单抗诱导的受者排斥反应发生率更高，而抗胸腺细胞球蛋白组更常观察到 PTLD。
