Abstract：
Blood group B kidney transplant candidates have lower transplantation rates and longer waiting times compared to other blood groups. Kidney transplantation from blood group A2-to-B has offered a solution for these patients. This study aimed to investigate the impact of Basiliximab and Alemtuzumab induction therapies on kidney function and de novo donor-specific antibodies (DSA) in blood type A2-to-B kidney transplant recipients within the first 12 months of post-transplant.
A retrospective analysis was conducted on 110 consecutive A2-to-B kidney transplant recipients between January 2015 and December 2022. Of these, 46 (41.8%) received Basiliximab, while 64 (58.2%) received Alemtuzumab as induction therapy. Demographics and comorbidities data were collected and compared between the two groups. Serum samples collected at 4- and 12-month intervals post-transplant were used to assess the presence of de novo DSA. Kidney allograft function was evaluated by monitoring serum creatinine levels and assessing Creatinine Clearance based on 24-h urine collection at various time points.
During the follow-up period, 20.00% of patients who received Alemtuzumab developed de novo DSA, whereas none of the patients induced with Basiliximab developed de novo DSA (p = 0.038). Recipients who received Basiliximab were older (mean age = 72.00) and received higher Kidney Donor Profile Index (KDPI) kidneys (mean = 75) compared to those induced with Alemtuzumab (mean age = 58.00, mean KDPI = 49) (p < 0.001), with no significant difference observed in the last follow-up creatinine clearance or creatinine levels between the two groups (p = 0.28).
The use of Basiliximab as induction immunosuppression in A2-to-B kidney transplant recipients is associated with a lower incidence of de novo HLA DSA formation without significant differences in overall renal function compared to Alemtuzumab.
A retrospective analysis was conducted on 110 consecutive A2-to-B kidney transplant recipients between January 2015 and December 2022. Of these, 46 (41.8%) received Basiliximab, while 64 (58.2%) received Alemtuzumab as induction therapy. Demographics and comorbidities data were collected and compared between the two groups. Serum samples collected at 4- and 12-month intervals post-transplant were used to assess the presence of de novo DSA. Kidney allograft function was evaluated by monitoring serum creatinine levels and assessing Creatinine Clearance based on 24-h urine collection at various time points.
During the follow-up period, 20.00% of patients who received Alemtuzumab developed de novo DSA, whereas none of the patients induced with Basiliximab developed de novo DSA (p = 0.038). Recipients who received Basiliximab were older (mean age = 72.00) and received higher Kidney Donor Profile Index (KDPI) kidneys (mean = 75) compared to those induced with Alemtuzumab (mean age = 58.00, mean KDPI = 49) (p < 0.001), with no significant difference observed in the last follow-up creatinine clearance or creatinine levels between the two groups (p = 0.28).
The use of Basiliximab as induction immunosuppression in A2-to-B kidney transplant recipients is associated with a lower incidence of de novo HLA DSA formation without significant differences in overall renal function compared to Alemtuzumab.
摘要：
目的：与其他血型相比，B血型肾移植患者的移植率更低，等待时间更长。从血型A2到B的肾移植为这些患者提供了解决方案。这项研究旨在研究巴利昔单抗和阿仑单抗诱导疗法对移植后的前12个月内A2至B血型肾移植受者的肾功能和从头供体特异性抗体（DSA）的影响。
方法：对2015年1月至2022年12月期间110例连续的A2-B肾移植受者进行了回顾性分析。其中,46例（41.8%）接受了巴利昔单抗，64例（58.2%）接受了Alemtuzumab作为诱导治疗。收集并比较两组人口统计学和合并症数据。移植后以4个月和12个月的间隔收集的血清样品用于评估从头DSA的存在。通过监测血清肌酐水平并根据不同时间点的24小时尿液收集评估肌酐清除率来评估肾脏同种异体移植功能。
结果：在随访期间，接受Alemtuzumab的患者中有20.00％的患者从头DSA，而巴利昔单抗诱导的患者均未出现从头DSA（p=0.038）。接受巴利昔单抗治疗的患者年龄较大（平均年龄=72.00），接受肾脏供者资料指数（KDPI）（平均=75），与使用阿仑珠单抗治疗的患者相比（平均年龄=58.00，平均KDPI=49）（p<0.001），两组末次随访肌酐清除率或肌酐水平无显著差异(p=0.28).
结论：与Alemtuzumab相比，在A2-to-B肾移植受者中使用巴利昔单抗作为诱导免疫抑制与从头HLADSA形成的发生率较低相关，而总体肾功能无显著差异。
方法：对2015年1月至2022年12月期间110例连续的A2-B肾移植受者进行了回顾性分析。其中,46例（41.8%）接受了巴利昔单抗，64例（58.2%）接受了Alemtuzumab作为诱导治疗。收集并比较两组人口统计学和合并症数据。移植后以4个月和12个月的间隔收集的血清样品用于评估从头DSA的存在。通过监测血清肌酐水平并根据不同时间点的24小时尿液收集评估肌酐清除率来评估肾脏同种异体移植功能。
结果：在随访期间，接受Alemtuzumab的患者中有20.00％的患者从头DSA，而巴利昔单抗诱导的患者均未出现从头DSA（p=0.038）。接受巴利昔单抗治疗的患者年龄较大（平均年龄=72.00），接受肾脏供者资料指数（KDPI）（平均=75），与使用阿仑珠单抗治疗的患者相比（平均年龄=58.00，平均KDPI=49）（p<0.001），两组末次随访肌酐清除率或肌酐水平无显著差异(p=0.28).
结论：与Alemtuzumab相比，在A2-to-B肾移植受者中使用巴利昔单抗作为诱导免疫抑制与从头HLADSA形成的发生率较低相关，而总体肾功能无显著差异。
