Jha Pranaw K, Bansal Shyam B, Sharma Reetesh, Sethi Sidharth K, Bansal Dinesh, Nandwani Ashish, Kher Ajay, Yadav Dinesh K, Gadde Ashwini, Mahapatra Amit K, Rana Abhyuday S, Sodhi Puneet, Jain Manish, Kher Vijay
Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta - The Medicity, Gurugram, Haryana, India.
Indian J Nephrol. 2024 May-Jun;34(3):246-251. doi: 10.4103/ijn.ijn_84_23. Epub 2023 Aug 10.
BACKGROUND: The role of induction in low-risk, living-donor kidney transplants being treated with tacrolimus, mycophenolate mofetil, and prednisolone is debatable. MATERIALS AND METHODS: This was a retrospective study that consisted of patients undergoing living kidney transplantation between February 2010 and June 2021 with a related haplomatch donor, with maintenance immunosuppression of tacrolimus, mycophenolate mofetil, and prednisolone. High-risk transplants, such as second or more transplants, immunologically incompatible transplants, and steroid-free transplants, were excluded. Patients were divided into three groups: no induction, basiliximab induction, and thymoglobulin induction, and the outcomes of all three were compared. RESULTS: A total of 350 transplants were performed. There was a significant difference in the recipient sex distribution ( = 0.0373) and the number of preemptive transplants ( = 0.0272) between the groups. Other parameters were comparable. Biopsy-proven acute rejection (BPAR) was significantly less frequent in the thymoglobulin group than in the no-induction (5.3% vs. 17.5%; = 0.0051) or basiliximab (5.3% vs. 18.8%; = 0.0054) group. This persisted even after we performed multivariate regression analysis (thymoglobulin vs. no-induction group, = 0.0146; thymoglobulin vs. basiliximab group, = 0.0237). There was no difference in BPAR between the basiliximab and no-induction groups. There were no differences in other outcomes between the groups. CONCLUSION: In a low-risk haplomatch, related, living-donor kidney transplant on tacrolimus, mycophenolate mofetil, and prednisolone, BPAR was significantly lower with thymoglobulin as opposed to no induction or basiliximab induction with a similar short-term patient and death-censored graft survival and infection rates. Basiliximab did not provide any benefit over no induction.
背景:在接受他克莫司、霉酚酸酯和泼尼松龙治疗的低风险活体供肾移植中,诱导治疗的作用存在争议。 材料与方法:这是一项回顾性研究,纳入了2010年2月至2021年6月间接受亲属单倍型匹配供体活体肾移植的患者,维持免疫抑制方案为他克莫司、霉酚酸酯和泼尼松龙。排除高风险移植,如二次或更多次移植、免疫不相容移植和无类固醇移植。患者分为三组:未进行诱导治疗组、巴利昔单抗诱导治疗组和抗胸腺细胞球蛋白诱导治疗组,并比较三组的结局。 结果:共进行了350例移植手术。各组间受者性别分布(P = 0.0373)和先发制人移植的数量(P = 0.0272)存在显著差异。其他参数具有可比性。经活检证实的急性排斥反应(BPAR)在抗胸腺细胞球蛋白组中的发生率显著低于未诱导治疗组(5.3% 对17.5%;P = 0.0051)或巴利昔单抗组(5.3% 对18.8%;P = 0.0054)。即使在进行多因素回归分析后,这种差异仍然存在(抗胸腺细胞球蛋白组与未诱导治疗组比较,P = 0.0146;抗胸腺细胞球蛋白组与巴利昔单抗组比较,P = 0.0237)。巴利昔单抗组和未诱导治疗组之间的BPAR无差异。各组间其他结局无差异。 结论:在接受他克莫司、霉酚酸酯和泼尼松龙治疗的低风险单倍型匹配、亲属活体供肾移植中,与未诱导治疗或巴利昔单抗诱导治疗相比,抗胸腺细胞球蛋白诱导治疗的BPAR显著更低,且患者短期生存率、死亡截尾的移植物生存率和感染率相似。巴利昔单抗诱导治疗与未诱导治疗相比未显示出任何益处。
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