Ahn JiYoon B, Bae Sunjae, Chu Nadia M, Wang Lingyu, Kim Jongyeon, Schnitzler Mark, Hess Gregory P, Lentine Krista L, Segev Dorry L, McAdams-DeMarco Mara A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Transplant Direct. 2021 Jun 18;7(7):e715. doi: 10.1097/TXD.0000000000001105. eCollection 2021 Jul.
Among adult kidney transplant (KT) recipients, the risk of post-KT adverse outcomes differs by type of induction immunosuppression. Immune response to induction differs as recipients age; yet, choice of induction is barely tailored by age likely due to a lack of evidence of the risks and benefits.
Using Scientific Registry of Transplant Recipients data, we identified 39336 first-time KT recipients (2010-2016). We estimated the length of stay (LOS), acute rejection (AR), graft failure, and death by induction type using logistic and Cox regression weighted by propensity score to adjust for confounders. We tested whether these estimates differed by age (65+ versus 18-64 y) using a Wald test.
Overall, rabbit antithymocyte globulin (rATG) was associated with a decreased risk of AR (odds ratio = 0.79, 95% confidence interval [CI], 0.72-0.85) compared with basiliximab. The effect of induction on LOS and death (interaction = 0.03 and 0.003) differed by recipient age. Discharge was on average 11% shorter in rATG among younger recipients (relative time = 0.89; 95% confidence interval [CI], 0.81-0.99) but not among older recipients (relative time = 1.01; 95% CI, 0.95-1.08). rATG was not associated with mortality among older (hazard ratio = 1.05; 95% CI, 0.96-1.15), but among younger recipients (hazard ratio = 0.87; 95% CI, 0.80-0.95), it was associated with reduced mortality risk.
rATG should be considered to prevent AR, especially among recipients with high-immunologic risk regardless of age; however, choice of induction should be tailored to reduce LOS and risk of mortality, particularly among younger recipients.
在成年肾移植（KT）受者中，KT术后不良结局的风险因诱导免疫抑制类型而异。随着受者年龄增长，对诱导治疗的免疫反应有所不同；然而，由于缺乏风险和获益的证据，诱导治疗的选择几乎没有根据年龄进行调整。
利用移植受者科学注册系统的数据，我们确定了39336例首次接受KT的受者（2010 - 2016年）。我们使用倾向评分加权的逻辑回归和Cox回归来估计住院时间（LOS）、急性排斥反应（AR）、移植失败和死亡情况，以调整混杂因素。我们使用Wald检验来检验这些估计值在年龄（65岁及以上与18 - 64岁）方面是否存在差异。
总体而言，与巴利昔单抗相比，兔抗胸腺细胞球蛋白（rATG）与AR风险降低相关（比值比 = 0.79，95%置信区间[CI]，0.72 - 0.85）。诱导治疗对LOS和死亡的影响（交互作用 = 0.03和0.003）因受者年龄而异。在年轻受者中，rATG组的出院时间平均缩短11%（相对时间 = 0.89；95%置信区间[CI]，0.81 - 0.99），而在老年受者中则不然（相对时间 = 1.01；95% CI，0.95 - 1.08）。rATG与老年受者的死亡率无关（风险比 = 1.05；95% CI，0.96 - 1.15），但在年轻受者中（风险比 = 0.87；95% CI，0.80 - 0.95），它与降低死亡风险相关。
应考虑使用rATG预防AR，尤其是在免疫风险高的受者中，无论其年龄如何；然而，诱导治疗的选择应根据年龄进行调整，以减少LOS和死亡风险，特别是在年轻受者中。
