Cerise Adam, Shaker Tamer, LeNguyen Phuoc, Dinesh Anant, Ramanathan Karthik, Humphreville Vanessa, Jackson Scott, Kandaswamy Raja, Riad Samy
Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN.
Complex Care Analytics, MHealth Fairview, Minneapolis, MN.
Transplant Direct. 2022 Nov 17;8(12):e1412. doi: 10.1097/TXD.0000000000001412. eCollection 2022 Dec.
Long-term outcome data by induction type in simultaneous pancreas-kidney (SPK) is limited.
Utilizing the Scientific Registry of Transplant Recipients, we examined all primary SPK transplants between 2000 and 2020, excluding crossmatch-positive recipients. We grouped recipients according to induction regimen into 3 groups: rabbit anti-thymocyte globulin (r-ATG) (n = 5678), alemtuzumab (n = 1199), and interleukin-2 receptor antagonist (IL-2RA; n = 1593). We analyzed the 10-y recipient and composite (kidney and pancreas) graft survival using the Kaplan-Meier survival function. Cox-proportion hazard models were generated to examine the association between induction type, the 10-y recipient, and graft survival. Models were adjusted for recipient age, sex, ethnicity, HLA-mismatch, diabetes type, dialysis dependency, cold-ischemia time, local versus imported organs, panel reactive antibody, steroid maintenance, and Pancreas Donor Risk Index.
r-ATG was associated with the lowest 1-y kidney and pancreas rejection rates compared with other agents ( < 0.001). In the univariable analysis, induction type was not associated with recipient (log-rank = 0.11) or graft survival (log-rank = 0.36). In the multivariable model for the composite graft survival, alemtuzumab use was associated with 22% increased kidney or pancreas graft loss compared with r-ATG (adjusted hazard ratio, 1.22; 95% confidence interval, 1.05-1.42), whereas IL-2RA use was not a predictor of graft survival. Induction type did not influence recipient survival in the adjusted model.
r-ATG use was associated with the lowest SPK rejection rates. Compared with r-ATG, alemtuzumab but not IL-2RA was associated with worse long-term death-censored SPK graft outcome. Our analysis supports the common use of r-ATG for induction in US primary SPK recipients.
关于同期胰肾联合移植（SPK）中不同诱导类型的长期结局数据有限。
利用移植受者科学注册系统，我们研究了2000年至2020年间所有原发性SPK移植，排除交叉配型阳性受者。我们根据诱导方案将受者分为3组：兔抗胸腺细胞球蛋白（r-ATG）组（n = 5678）、阿仑单抗组（n = 1199）和白细胞介素-2受体拮抗剂（IL-2RA；n = 1593）。我们使用Kaplan-Meier生存函数分析了10年受者及复合（肾脏和胰腺）移植物生存率。生成Cox比例风险模型以检验诱导类型、10年受者及移植物生存率之间的关联。模型针对受者年龄、性别、种族、HLA错配、糖尿病类型、透析依赖、冷缺血时间、本地器官与进口器官、群体反应性抗体、类固醇维持治疗以及胰腺供体风险指数进行了调整。
与其他药物相比，r-ATG与最低的1年肾脏和胰腺排斥率相关（<0.001）。在单变量分析中，诱导类型与受者生存率（对数秩 = 0.11）或移植物生存率（对数秩 = 0.36）无关。在复合移植物生存率的多变量模型中，与r-ATG相比，使用阿仑单抗与肾脏或胰腺移植物丢失增加22%相关（调整后风险比，1.22；95%置信区间，1.05 - 1.42），而使用IL-2RA不是移植物生存率的预测因素。在调整后的模型中，诱导类型不影响受者生存率。
使用r-ATG与最低的SPK排斥率相关。与r-ATG相比，阿仑单抗而非IL-2RA与长期死亡校正后的SPK移植物结局较差相关。我们的分析支持在美国原发性SPK受者中普遍使用r-ATG进行诱导治疗。
