Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana.
Am J Transplant. 2022 Nov;22(11):2586-2597. doi: 10.1111/ajt.17130. Epub 2022 Jul 8.
Black heart transplant recipients are more likely to receive induction immunosuppression compared to other races because of higher rates of acute rejection, graft failure, and mortality. However, it is not known whether contemporary induction immunosuppression improves their post-transplant outcomes. To evaluate whether Black patients who were prescribed induction immunosuppression therapy have lower all-cause mortality or graft-failure rates compared to those who were not, we studied Black U.S. adult heart transplant recipients in the Scientific Registry of Transplant Recipients database (2008-2018). We used multivariable Cox proportional hazards regression analysis to compare the hazards of all-cause mortality or graft failure as a composite, for patients who were prescribed induction immunosuppression and those who were not. Among 5160 recipients, 2787 (54.0%) were prescribed induction immunosuppression and 2373 (46.0%) were not. There was no evidence of survival differences according to induction immunosuppression for the composite of all-cause mortality or graft failure (aHR = 1.13, 95% CI 0.96-1.32), mortality (aHR = 1.14, 95% CI 0.97-1.34), graft failure (aHR = 1.05, 95% CI 0.82-1.34) and acute rejection (aHR = 1.00, 95% CI 0.89-1.12). Given the side effects of treatment, future guidelines should reconsider the recommendation for induction immunosuppression among Black patients.
黑人心脏移植受者因急性排斥反应、移植物衰竭和死亡率较高，与其他种族相比，更有可能接受诱导免疫抑制治疗。然而，目前尚不清楚当代诱导免疫抑制治疗是否能改善他们的移植后结局。为了评估与未接受诱导免疫抑制治疗的患者相比，接受诱导免疫抑制治疗的黑人患者的全因死亡率或移植物衰竭率是否更低，我们研究了美国科学器官移植受者登记处（2008-2018 年）数据库中的黑人成年心脏移植受者。我们使用多变量 Cox 比例风险回归分析比较了接受和未接受诱导免疫抑制治疗的患者的全因死亡率或移植物衰竭复合终点的风险比。在 5160 名受者中，2787 名（54.0%）接受了诱导免疫抑制治疗，2373 名（46.0%）未接受。根据诱导免疫抑制治疗，在全因死亡率或移植物衰竭复合终点（aHR=1.13，95%CI 0.96-1.32）、死亡率（aHR=1.14，95%CI 0.97-1.34）、移植物衰竭（aHR=1.05，95%CI 0.82-1.34）和急性排斥反应（aHR=1.00，95%CI 0.89-1.12）方面，均未发现生存差异。鉴于治疗的副作用，未来的指南应该重新考虑在黑人患者中推荐诱导免疫抑制治疗。
