Division of Transplant, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
Division of Nephrology, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
Kidney360. 2020 Oct 1;1(12):1407-1418. doi: 10.34067/KID.0000122020. eCollection 2020 Dec 31.
Optimal induction for patients without pretransplant donor-specific antibodies (DSAs) is poorly defined. The goal of this study was to compare the incidence of DSA (dnDSA) and graft outcomes between induction therapies in patients with a negative virtual crossmatch (VXM).
A retrospective chart review was performed, identifying 782 patients with a negative VXM who underwent kidney transplantation at a single, high-volume institution between January 2013 and May 2017. Kaplan-Meier analysis was used to assess the incidence of dnDSA and allograft survival between induction therapies in this group. dnDSA is defined as the development of new post-transplant DSA, at any MFI level.
Induction therapy included alemtuzumab (=87, 11%), basiliximab (=522, 67%), and anti-thymocyte globulin (ATG; =173, 22%). One-year graft survival was similar between groups (alemtuzumab, 100%; basiliximab, 98%; ATG, 99%). Incidence of acute rejection at 1 year was <2% and not different between the three groups. Alemtuzumab was associated with the highest incidence of dnDSA at 14%, compared with 5% and 8% in basiliximab and ATG groups, respectively, at 1 year (=0.009). In multivariate regression analyses, alemtuzumab retained its significant association with a dnDSA HR of 2.5 (95% CI, 1.51 to 4.25; =0.0004).
In summary, alemtuzumab was associated with a higher rate of dnDSA development in patients with a negative VXM; however, this finding was not associated with rejection or graft failure.
对于无移植前供体特异性抗体（DSA）的患者，最佳诱导方案尚未明确。本研究旨在比较阴性虚拟交叉匹配（VXM）患者中不同诱导治疗方案的 DSA（dnDSA）发生率和移植物结局。
回顾性分析了 2013 年 1 月至 2017 年 5 月在单中心、高容量机构接受肾移植的 782 例阴性 VXM 患者的病历资料。采用 Kaplan-Meier 分析评估该组患者中不同诱导治疗方案之间 dnDSA 的发生率和移植物存活率。dnDSA 定义为任何 MFI 水平的移植后新出现的 DSA。
诱导治疗包括阿仑单抗（=87，11%）、巴利昔单抗（=522，67%）和抗胸腺细胞球蛋白（ATG；=173，22%）。各组 1 年移植物存活率相似（阿仑单抗组 100%，巴利昔单抗组 98%，ATG 组 99%）。1 年内急性排斥反应发生率<2%，且三组间无差异。与巴利昔单抗（5%）和 ATG（8%）组相比，阿仑单抗组 1 年时 dnDSA 发生率最高（14%），差异有统计学意义（=0.009）。多变量回归分析显示，阿仑单抗与 dnDSA 相关，风险比（HR）为 2.5（95%可信区间，1.51~4.25；=0.0004）。
综上所述，阴性 VXM 患者中，阿仑单抗与较高的 dnDSA 发生率相关，但这一发现与排斥反应或移植物失败无关。
