Ryan Randi J, Bentall Andrew J, Issa Naim, Dean Patrick G, Smith Byron H, Stegall Mark D, Riad Samy M
Division of Transplant Surgery, Intermountain Health, Murray, UT.
Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
Transplant Direct. 2024 Sep 25;10(10):e1698. doi: 10.1097/TXD.0000000000001698. eCollection 2024 Oct.
The impact of induction type or high-risk viral discordance on older kidney transplant recipients is unclear. Herein, we analyzed the association between induction type, viral discordance, and outcomes for older recipients.
We analyzed the Scientific Registry of Transplant Recipients standard analysis file for all primary kidney transplant recipients older than 55 y who were transplanted between 2005 and 2022. All transplants were crossmatch negative and ABO-compatible. Recipients were discharged on tacrolimus and mycophenolate ± steroids. Recipients were categorized into 3 groups by induction received: rabbit antithymocyte globulin (r-ATG; N = 51 079), interleukin-2 receptor antagonist (IL-2RA; N = 22 752), and alemtuzumab (N = 13 465). Kaplan-Meier curves were generated for recipient and graft survival, and follow-up was censored at 10 y. Mixed-effect Cox proportional hazard models examined the association between induction type, high-risk viral discordance, and outcomes of interest. Models were adjusted for pertinent recipient and donor characteristics.
Induction type did not predict recipient survival in the multivariable model, whereas Epstein-Barr virus high-risk discordance predicted 14% higher mortality (1.14 [1.07-1.21], < 0.01). In the multivariable model for death-censored graft survival, alemtuzumab, but not IL-2RA, was associated with an increased risk of graft loss (1.18 [1.06-1.29], < 0.01) compared with r-ATG. High-risk cytomegalovirus discordance predicted 10% lower death-censored graft survival (1.10 [1.01-1.19], < 0.02). Live donor and preemptive transplantation were favorable predictors of survival.
In this large cohort of older transplant recipients, alemtuzumab, but not IL-2RA, induction was associated with an increased risk of graft loss compared with r-ATG. Cytomegalovirus and Epstein-Barr virus high-risk viral discordance portended poor graft and recipient survival, respectively.
诱导类型或高风险病毒不一致对老年肾移植受者的影响尚不清楚。在此，我们分析了诱导类型、病毒不一致与老年受者结局之间的关联。
我们分析了移植受者科学注册中心的标准分析文件，纳入了2005年至2022年间接受首次肾移植的所有年龄大于55岁的受者。所有移植均为交叉配型阴性且ABO血型相容。受者出院时使用他克莫司和霉酚酸酯±类固醇。根据接受的诱导治疗将受者分为3组：兔抗胸腺细胞球蛋白（r-ATG；N = 51079）、白细胞介素-2受体拮抗剂（IL-2RA；N = 22752）和阿仑单抗（N = 13465）。生成了受者和移植物存活的Kaplan-Meier曲线，并在10年时进行随访截尾。混合效应Cox比例风险模型检验了诱导类型、高风险病毒不一致与感兴趣结局之间的关联。模型对相关的受者和供者特征进行了调整。
在多变量模型中，诱导类型不能预测受者存活，而爱泼斯坦-巴尔病毒高风险不一致预测死亡率高14%（1.14[1.07 - 1.21]，P < 0.01）。在死亡截尾的移植物存活多变量模型中，与r-ATG相比，阿仑单抗而非IL-2RA与移植物丢失风险增加相关（1.18[1.06 - 1.29]，P < 0.01）。高风险巨细胞病毒不一致预测死亡截尾的移植物存活低10%（1.10[1.01 - 1.
