背景:我们假设在小儿肾移植受者(KTR)中使用阿仑珠单抗是安全的,与其他诱导剂相比,其长期结局相同。
方法:使用UNOS数据库中2000年1月1日至2022年6月30日之间的小儿肾移植受者数据,多变量逻辑回归,多变量Cox回归,和生存分析被用来估计第一年和所有时间住院的可能性,急性排斥反应,CMV感染,延迟移植物功能(DGF),移植物丢失,三种常见诱导方案的接受者中的患者死亡率(ATG,阿仑单抗,和巴利昔单抗)。
结果:在诱导或维持方案中,急性排斥反应或移植失败没有差异。巴利昔单抗与死亡供者中DGF的几率较低相关(OR0.77[0.60-0.99],p=.04)。接受含类固醇维持治疗的患者死亡率增加(HR1.3[1.005-1.7]p=.045)。与ATG相比,阿仑珠单抗诱导与CMV感染风险较低相关(OR0.76[0.59-0.99],p=.039)。与无类固醇维持相比,含类固醇维持的PTLD发生率较低(HR0.59[0.4-0.8]p=.001)。Alemtuzumab与移植后1年内(OR0.79[0.67-0.95]p=.012)和5年内(HR0.54[0.46-0.65]p<.001)住院风险较低相关。类固醇维持也降低了5年住院风险(HR0.78[0.69-0.89]p<.001)。
结论:阿仑珠单抗诱导可以安全地治疗小儿KTR,而不会增加急性排斥反应的风险,DGF,移植物丢失,或患者死亡率。与其他药物相比,CMV感染的风险降低和住院率降低,使阿仑单抗成为儿科KTR诱导的有吸引力的选择。尤其是那些不能忍受ATG的人。
BACKGROUND: We hypothesized that alemtuzumab use is safe in pediatric kidney transplant recipients (KTRs) with equivalent long-term outcomes compared to other induction agents.
METHODS: Using pediatric kidney transplant recipient data in the UNOS database between January 1, 2000, and June 30, 2022, multivariate logistic regression, multivariable Cox regression, and survival analyses were utilized to estimate the likelihoods of 1st-year and all-time hospitalizations, acute rejection, CMV infection, delayed graft function (DGF), graft loss, and patient mortality among recipients of three common induction regimens (ATG, alemtuzumab, and basiliximab).
RESULTS: There were no differences in acute rejection or graft failure among induction or maintenance regimens. Basiliximab was associated with lower odds of DGF in deceased donor recipients (OR 0.77 [0.60-0.99], p = .04). Mortality was increased in patients treated with steroid-containing maintenance (HR 1.3 [1.005-1.7] p = .045). Alemtuzumab induction correlated with less risk of CMV infection than ATG (OR 0.76 [0.59-0.99], p = .039). Steroid-containing maintenance conferred lower rate of PTLD compared to steroid-free maintenance (HR 0.59 [0.4-0.8] p = .001). Alemtuzumab was associated with less risk of hospitalization within 1 year (OR 0.79 [0.67-0.95] p = .012) and 5 years (HR 0.54 [0.46-0.65] p < .001) of transplantation. Steroid maintenance also decreased 5 years hospitalization risk (HR 0.78 [0.69-0.89] p < .001).
CONCLUSIONS: Pediatric KTRs may be safely treated with alemtuzumab induction without increased risk of acute rejection, DGF, graft loss, or patient mortality. The decreased risk of CMV infections and lower hospitalization rates compared to other agents make alemtuzumab an attractive choice for induction in pediatric KTRs, especially in those who cannot tolerate ATG.