Padhye Akhilesh Ajay, Guffey Danielle, Leon-Pena Andres, Segraves Justin, Fernandez Ramiro, Loor Gabriel, Garcha Puneet, Wu Tianshi David, Li Gloria
Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, United States.
Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States.
Front Transplant. 2025 Jul 4;4:1607678. doi: 10.3389/frtra.2025.1607678. eCollection 2025.
Lung transplantation has seen strides in survival over the past few decades, though long-term survival remains poor. Chronic lung allograft dysfunction (CLAD) is a leading cause of graft failure and mortality beyond the first year. Anti-thymocyte globulin (ATG) is commonly used for treating refractory CLAD, though its efficacy remains uncertain.
This retrospective study evaluated the impact of ATG on lung function decline and mortality among lung transplant recipients diagnosed with CLAD, defined as a persistent >20% decline in forced expiratory volume (FEV1) from baseline. Patients treated with ATG were compared to those who did not receive ATG, using mixed effects modeling for FEV1 decline and Fine-Gray competing risk modeling for mortality.
Of the 124 patients with CLAD, 55 (44%) received ATG. Administration was not associated with a significant change in FEV1 decline when compared to rate of decline prior to ATG administration [-0.0881 L/year, 95% CI (-0.21, 0.034)] or compared to non-ATG recipients [0.0599 L/year, 95% CI (-0.057, 0.18)]. However, ATG was associated with a lower hazard of all-cause mortality [subhazard ratio 0.66, 95% CI (0.39-1.14)].
While ATG improved survival, it did not alter lung function decline, affirming the need for prospective randomized studies.
在过去几十年中，肺移植在提高生存率方面取得了进展，尽管长期生存率仍然较低。慢性肺移植功能障碍（CLAD）是移植失败和第一年以后死亡率的主要原因。抗胸腺细胞球蛋白（ATG）常用于治疗难治性CLAD，但其疗效仍不确定。
这项回顾性研究评估了ATG对诊断为CLAD的肺移植受者肺功能下降和死亡率的影响，CLAD定义为用力呼气量（FEV1）自基线持续下降>20%。将接受ATG治疗的患者与未接受ATG治疗的患者进行比较，使用混合效应模型分析FEV1下降情况，使用Fine-Gray竞争风险模型分析死亡率。
在124例CLAD患者中，55例（44%）接受了ATG治疗。与ATG给药前的下降率相比[-0.0881升/年，95%置信区间（-0.21，0.034）]，或与未接受ATG治疗的患者相比[0.0599升/年，95%置信区间（-0.057，0.18）]，ATG给药与FEV1下降的显著变化无关。然而，ATG与全因死亡率较低相关[亚风险比0.66，95%置信区间（0.39 - 1.14）]。
虽然ATG提高了生存率，但并未改变肺功能下降情况，这证实了进行前瞻性随机研究的必要性。
