Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Pharmacy, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clin Transplant. 2024 Apr;38(4):e15307. doi: 10.1111/ctr.15307.
The use of induction immunosuppression for heart transplantation (HT) is debated given the uncertain benefit and potential risks of infection and malignancy.
This is a retrospective single-center analysis of 475 consecutive HT recipients from 2003 to 2020 grouped by use of induction with basiliximab group (BG) and the no basiliximab group (NBG). Subgroup analysis by era compared pre-2016 standard-basiliximab (BX) induction and 2016-2020 with selective-BX use as part of a calcineurin-inhibitor-sparing regimen.
When adjusted for confounders (sex, age, PRA, eGFR), the BG was less likely to have acute cellular rejection (ACR) (OR.42, p < .001), but had more antibody mediated rejection (AMR) (OR 11.7, p < .001) and more cardiac allograft vasculopathy (CAV) (OR 3.8, p = .04). There was no difference between BG and NBG in the incidence of malignancies or infections. When stratified by era (pre-2016 vs. 2016-2020), ACR remained less common in the BG than the NBG (36% vs. 50%, p = .045) groups, while AMR remained more common (9.7 vs. 0% p = .005). There was no significant difference in conditional survival comparing pre-and post-2016 NBG (HR 2.20 (95% CI.75-6.43); however, both pre-2016 BG and post-2016 BG have significantly higher mortality (HR 2.37 [95% CI 1.02-5.50) and HR 2.69 (95% CI 1.08-6.71), p = .045 and.03, respectively].
Basiliximab reduces the incidence of ACR but increases the risk of AMR, CAV, and may be associated with increased mortality. Mechanistic studies are needed to describe a potential T-cell-escape mechanism with enhanced humoral immunity.
由于诱导免疫抑制在心脏移植（HT）中的获益不确定且存在感染和恶性肿瘤的潜在风险，其应用存在争议。
这是一项回顾性单中心分析，纳入了 2003 年至 2020 年间 475 例连续接受 HT 的患者，根据使用巴利昔单抗诱导组（BG）和未使用巴利昔单抗组（NBG）进行分组。通过比较 2016 年前标准巴利昔单抗（BX）诱导和 2016-2020 年选择性使用 BX 作为钙调神经磷酸酶抑制剂节约方案的一部分的亚组分析，对不同时期进行分析。
在调整混杂因素（性别、年龄、PRA、eGFR）后，BG 发生急性细胞排斥反应（ACR）的可能性较低（OR.42，p<0.001），但发生抗体介导排斥反应（AMR）的可能性更高（OR 11.7，p<0.001）和心脏移植物血管病（CAV）的可能性更高（OR 3.8，p=0.04）。BG 和 NBG 在恶性肿瘤或感染的发生率方面无差异。按时期分层（2016 年前与 2016-2020 年），BG 比 NBG 的 ACR 更常见（36%比 50%，p=0.045），而 AMR 更常见（9.7%比 0%，p=0.005）。比较 2016 年前和 2016 年后的 NBG 条件生存率无显著差异（HR 2.20（95%CI.75-6.43）；然而，2016 年前的 BG 和 2016 年后的 BG 死亡率均显著升高（HR 2.37 [95%CI 1.02-5.50]和 HR 2.69 [95%CI 1.08-6.71]，p=0.045 和 p=0.03）。
巴利昔单抗可降低 ACR 发生率，但增加 AMR、CAV 风险，可能与死亡率升高相关。需要进行机制研究以描述潜在的 T 细胞逃逸机制和增强的体液免疫。
