Pharmacy Services, Alberta Health Services, Edmonton, Canada.
Department of Medicine, University of Alberta, Division of Cardiology, Edmonton, Canada.
Clin Transplant. 2024 Jun;38(6):e15332. doi: 10.1111/ctr.15332.
Patients undergoing heart transplants are at risk of rejection which can have significant morbidity and mortality. Induction immunosuppression at the time of transplant reduces the early risk and has additional benefits. The induction agent of choice within our program was changed from rabbit antithymocyte-globulin (rATG) to basiliximab, so it was necessary to evaluate whether this had any impact on patient outcomes.
Our primary objective was to describe rejection, infection, and other outcomes in adult heart transplant patients at the University of Alberta Hospital in Edmonton, Canada.
This study was a nonrandomized, retrospective cohort study.
Sixty-three patients were included with median ages 50 years versus 54 years. More female patients received rATG (20% vs. 42.4%). The most common indication for transplant in both cohorts was ICM (63.3% vs. 57.6%). Patients who received rATG had significantly higher PRA (0% vs. 43%, p < .001). Acute rejection episodes were similar between basiliximab and rATG at 3 months (16.7% vs. 15.1%; p = 1.0) and 6-months (30.0% vs. 18.1%; p = .376). Infections were not statistically different with basiliximab compared to rATG at 3-months, 43.3% vs. 63.6% and at 6-months 60.0% vs. 66.7%). There were no fatalities in either group.
Our study did not demonstrate differences in rejection with basiliximab compared to rATG. Mortality did not differ, but basiliximab-treated patients had fewer infections and infection-related hospitalizations than those treated with rATG. Larger studies with longer durations are needed to more completely describe the differences in rejection and infectious outcomes.
接受心脏移植的患者存在排斥反应的风险，这可能会导致严重的发病率和死亡率。移植时的诱导免疫抑制可降低早期风险，并具有额外的益处。在我们的项目中，选择的诱导剂已从兔抗胸腺细胞球蛋白（rATG）改为巴利昔单抗，因此有必要评估这是否对患者的结局有任何影响。
我们的主要目的是描述加拿大埃德蒙顿阿尔伯塔大学医院成年心脏移植患者的排斥反应、感染和其他结局。
这是一项非随机、回顾性队列研究。
共纳入 63 例患者，中位年龄分别为 50 岁和 54 岁。接受 rATG 的女性患者比例更高（20%比 42.4%）。两个队列中最常见的移植适应证均为缺血性心肌病（63.3%比 57.6%）。接受 rATG 的患者的 PRA 显著更高（0%比 43%，p<0.001）。在 3 个月和 6 个月时，巴利昔单抗组和 rATG 组的急性排斥反应发生率相似（16.7%比 15.1%，p=1.0；30.0%比 18.1%，p=0.376）。在 3 个月时，巴利昔单抗组的感染率与 rATG 组相比无统计学差异（43.3%比 63.6%），在 6 个月时两组的感染率也无统计学差异（60.0%比 66.7%）。两组均无死亡病例。
与 rATG 相比，我们的研究并未显示巴利昔单抗在排斥反应方面的差异。死亡率没有差异，但与 rATG 治疗组相比，接受巴利昔单抗治疗的患者感染和感染相关住院的次数更少。需要进行更大规模、更长期的研究来更全面地描述排斥反应和感染结局的差异。
