Kitto Brent, Thai Steven, Baetz Brooke, Patel Hamang M, Mandras Stacy A, Desai Sapna, Krim Selim R
Department of Pharmacy, Ochsner Clinic Foundation, New Orleans, LA.
Section of Cardiomyopathy and Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2021 Summer;21(2):133-138. doi: 10.31486/toj.20.0024.
Induction with lymphocyte-depleting antibodies may improve allograft outcomes in heart transplant recipients who are at high immunologic risk for rejection. We conducted a single-center retrospective cohort study that compared outcomes between adult patients receiving rabbit antithymocyte globulin (rATG) induction vs no induction from 2011 through 2017. Key exclusion criteria were patients who did not receive tacrolimus and mycophenolate and patients who did not meet high immunologic risk criteria. A total of 50 patients were included in the analysis. At 1 year, the composite primary outcome of ≥2R rejection as defined by the International Society for Heart and Lung Transplantation, any treated rejection, development of cardiac allograft vasculopathy, or graft loss was not different between groups (=0.474). Serious infections were also similar between groups (=0.963). In accordance with institutional guidelines, prednisone exposure was decreased in the rATG induction group at 1 month (24.04 mg ± 13.74 vs 35.18 mg ± 16.95; =0.014). These results suggest that while rATG induction does not improve heart allograft outcomes, it may enable reducing early corticosteroid exposure in patients at high immunologic risk.
对于有高免疫排斥风险的心脏移植受者，使用淋巴细胞清除抗体进行诱导治疗可能会改善同种异体移植的结局。我们进行了一项单中心回顾性队列研究，比较了2011年至2017年接受兔抗胸腺细胞球蛋白（rATG）诱导治疗与未接受诱导治疗的成年患者的结局。主要排除标准为未接受他克莫司和霉酚酸酯的患者以及不符合高免疫风险标准的患者。共有50例患者纳入分析。1年时，根据国际心肺移植学会定义的≥2R排斥反应、任何接受治疗的排斥反应、心脏同种异体血管病变的发生或移植物丢失的复合主要结局在两组之间无差异（P=0.474）。两组之间的严重感染情况也相似（P=0.963）。根据机构指南，rATG诱导治疗组在1个月时泼尼松的暴露量降低（24.04 mg±13.74 vs 35.18 mg±16.95；P=0.014）。这些结果表明，虽然rATG诱导治疗不能改善心脏同种异体移植的结局，但它可能使高免疫风险患者早期皮质类固醇暴露量减少。
