Hong Su Yeon, Kim Young Soo, Jin Kyubok, Han Seungyeup, Yang Chul Woo, Chung Byung Ha, Park Woo Yeong
Transplant Research Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
Kidney Res Clin Pract. 2023 Jan;42(1):138-148. doi: 10.23876/j.krcp.21.159. Epub 2023 Jan 31.
Generally, an induction agent is chosen based on the conditions of the deceased donor and the recipient. Antithymocyte globulin (ATG) is preferred in relatively high-risk conditions. No clear evidence indicates which induction agent is safer or more efficient for deceased donor kidney transplantation (DDKT). This study compares the efficacy and safety of basiliximab (BSX) and ATG according to donor characteristics in DDKT.
A total of 724 kidney transplant recipients from three transplant centers were enrolled, and propensity score matching was performed. Based on a donor age of 60 years, donor kidney with acute kidney injury (AKI), and Kidney Donor Profile Index (KDPI) score of 65%, we investigated how the choice of induction therapy agent affected the posttransplant clinical outcomes of delayed graft function (DGF), acute rejection (AR), infectious complications, and allograft and patient survival.
AR and DGF did not differ significantly according to induction agent in elderly/young donor, AKI/non-AKI, and high-KDPI/ low-KDPI subgroups. The infection rate did not show meaningful differences. The differences in death-censored allograft survival and patient survival rates between induction agents were not statistically significant.
Our study suggests that BSX can produce clinical outcomes similarly favorable to those of ATG even in DDKT cases with relatively poor donor conditions. Nonetheless, the donor and recipient conditions, immunological risk, and infection risk must be all taken into consideration when choosing an induction agent. Therefore, clinicians should carefully select the induction therapy agent for DDKT based on the risks and benefits in each DDKT case.
一般来说，诱导剂是根据已故供体和受体的情况来选择的。在相对高风险的情况下，抗胸腺细胞球蛋白（ATG）是首选。没有明确的证据表明哪种诱导剂对于已故供体肾移植（DDKT）更安全或更有效。本研究根据DDKT中供体的特征比较了巴利昔单抗（BSX）和ATG的疗效和安全性。
共纳入来自三个移植中心的724名肾移植受者，并进行倾向评分匹配。基于供体年龄60岁、供体肾伴有急性肾损伤（AKI）以及肾脏供体概况指数（KDPI）评分65%，我们研究了诱导治疗药物的选择如何影响移植后延迟移植肾功能（DGF）、急性排斥反应（AR）、感染并发症以及移植物和患者生存的临床结局。
在老年/年轻供体、AKI/非AKI以及高KDPI/低KDPI亚组中，根据诱导剂的不同，AR和DGF没有显著差异。感染率没有显示出有意义的差异。诱导剂之间在死亡删失的移植物存活率和患者存活率方面的差异没有统计学意义。
我们的研究表明，即使在供体条件相对较差的DDKT病例中，BSX也能产生与ATG相似的良好临床结局。尽管如此，在选择诱导剂时，必须综合考虑供体和受体的条件、免疫风险和感染风险。因此，临床医生应根据每个DDKT病例的风险和益处，为DDKT仔细选择诱导治疗药物。
