Jarmi Tambi, Khouzam Samir, Shekhar Nitika, Hosni Meray, White Launia, Hodge David O, Mai Martin L, Wadei Hani M
Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
J Clin Med Res. 2020 Dec;12(12):787-793. doi: 10.14740/jocmr4369. Epub 2020 Dec 18.
Improvement in short-term outcomes after kidney transplant has been achieved by using different induction and maintenance therapeutic approaches. Long-term outcomes have not matched the expectations of the transplant stakeholders. Our study aimed to address the early impact of induction agents on long-term outcome of kidney transplant when measured by iothalamate clearance.
All adult kidney transplant recipients between January of 2012 and December of 2016 were reviewed. Six hundred forty-nine patients were divided into three groups based on the induction agent (basiliximab, alemtuzumab, and thymoglobulin). Protocoled 4 months and 48 months kidney allograft function evaluations with iothalamate clearance test were compared among the three groups.
Patients who received basiliximab were significantly older with no difference among African American and Caucasians. The 48 months assessment showed significant decline in median iothalamate clearance in basiliximab group at 49 mL/min vs. alemtuzumab group 64.8 mL/min and thymoglobulin 60 mL/min with P = 0.007. The basiliximab group developed a significant higher proteinuria measured by spot urine to creatinine ratio at 48 months.
The use of basiliximab as an induction agent for kidney transplant is associated with significant decline in kidney function 4 years post transplantation when measured by iothalamate clearance.
通过采用不同的诱导和维持治疗方法，肾移植后的短期预后已有所改善。然而，长期预后并未达到移植利益相关者的期望。我们的研究旨在通过碘他拉酸盐清除率来评估诱导剂对肾移植长期预后的早期影响。
回顾了2012年1月至2016年12月期间所有成年肾移植受者。根据诱导剂（巴利昔单抗、阿仑单抗和抗胸腺细胞球蛋白）将649例患者分为三组。比较了三组在4个月和48个月时通过碘他拉酸盐清除率试验进行的移植肾功能评估结果。
接受巴利昔单抗治疗的患者年龄显著较大，非裔美国人和白种人之间无差异。48个月的评估显示，巴利昔单抗组的碘他拉酸盐清除率中位数显著下降，为49 mL/min，而阿仑单抗组为64.8 mL/min，抗胸腺细胞球蛋白组为60 mL/min，P = 0.007。在48个月时，通过随机尿肌酐比值测量，巴利昔单抗组的蛋白尿显著更高。
以碘他拉酸盐清除率衡量，使用巴利昔单抗作为肾移植的诱导剂与移植后4年肾功能的显著下降有关。
