Lee Grace Pui-Yun, Cheng Richard K, Vasbinder Alexi, Wu Sixuan, Wong Beatrice, Farris Stephen D, Fishbein Daniel, Wong Jenny Man-Ching
Department of Pharmacy, University of Washington, Seattle, WA.
Division of Cardiology, University of Washington, Seattle, WA.
Transplant Direct. 2022 May 26;8(6):e1329. doi: 10.1097/TXD.0000000000001329. eCollection 2022 Jun.
The dosing intensity of antithymocyte globulin as induction therapy in heart transplantation remains controversial. We sought to evaluate the efficacy and safety of rabbit antithymocyte globulin at a total dose of 4.5 mg/kg compared with <4.5 mg/kg.
This was a retrospective study of consecutive patients who underwent heart transplantation from January 2016 to December 2018 at a single quaternary care center. Exposure was defined as full antithymocyte globulin (4.5 mg/kg total) induction compared with partial (<4.5 mg/kg) induction. The primary outcome was the incidence of The International Society for Heart and Lung Transplantation 1990 acute cellular rejection grade 2 or above at 2 y. Secondary outcomes were all-cause mortality, number of infections, and time to therapeutic tacrolimus levels. Cox proportional hazard models were used to compare rejection rates and mortality.
Of 201 patients, 61 received partial and 140 received full induction. There was no difference in the cumulative incidence of cellular rejection grade 2 or above (18% versus 11.4%, = 0.209) within 2 y. The adjusted hazard ratio was 1.45 (confidence interval: 0.62-3.37, = 0.388) for partial compared with full induction for any grade rejection. Landmark survival analysis conditional on survival to 1 mo showed no difference in mortality ( = 0.239). There was no difference in the incidence of infection within 3 mo of transplant (partial 29.5% versus full 20.0%, = 0.140). Both groups achieved therapeutic tacrolimus levels by day 7 after initiation.
There was no difference in overall risk for any grade cellular rejection between partial or full dose induction therapy. Additionally, there was no difference in medium-term mortality from landmark survival analysis.
抗胸腺细胞球蛋白作为心脏移植诱导治疗的给药强度仍存在争议。我们试图评估总剂量为4.5mg/kg的兔抗胸腺细胞球蛋白与<4.5mg/kg相比的疗效和安全性。
这是一项对2016年1月至2018年12月在单一四级医疗中心接受心脏移植的连续患者的回顾性研究。暴露定义为与部分（<4.5mg/kg）诱导相比的全剂量抗胸腺细胞球蛋白（总剂量4.5mg/kg）诱导。主要结局是2年时国际心肺移植学会1990年急性细胞排斥反应2级或以上的发生率。次要结局是全因死亡率、感染次数和达到治疗性他克莫司水平的时间。使用Cox比例风险模型比较排斥率和死亡率。
在201例患者中，61例接受部分诱导，140例接受全剂量诱导。2年内2级或以上细胞排斥反应的累积发生率无差异（18%对11.4%，P = 0.209）。对于任何级别的排斥反应，部分诱导与全剂量诱导相比，调整后的风险比为1.45（置信区间：0.62 - 3.37，P = 0.388）。以存活至1个月为条件的地标性生存分析显示死亡率无差异（P = 0.239）。移植后3个月内感染发生率无差异（部分诱导29.5%对全剂量诱导20.0%，P = 0.140）。两组在开始后第7天均达到治疗性他克莫司水平。
部分或全剂量诱导治疗在任何级别的细胞排斥反应总体风险上无差异。此外，地标性生存分析显示中期死亡率无差异。
