Alemtuzumab Equalizes Short Term Outcomes in High Risk PRA Patients: Long Term Outcomes Suffer
Alemtuzumab Equalizes Short Term Outcomes in High Risk PRA Patients: Long Term Outcomes Suffer
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阿仑单抗可平衡高风险 PRA 患者的短期结果：长期结果受到影响
DOI：
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
J. Ortiz
中科院分区：
文献类型：
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作者：
M. Naji;S. Ad;O. Ekwenna;G. Mitro;M. Rees;J. Ortiz
简介：Alemtuzumab是一种在大约13%的肾移植中使用的单抗，它允许早期停用糖皮质激素。以群体反应性抗体(PRA)升高为定义的高危患者，发生排斥反应的风险更高，移植结果更差，并已被证明受益于阿仑图珠单抗的诱导。这项研究的目的是评估免疫敏感型肾移植受者在使用阿伦图珠单抗诱导和早期停用类固醇后的结果。
方法：对2006年3月至2015年11月的668例移植受者进行回顾性分析，所有受者均接受阿伦图珠单抗诱导。将高危患者(定义为PRA和GT；20%)与低PRA(定义为PRA和GT；20%)进行比较。评估结果，如患者存活率、移植物存活率和排斥反应。
结果：两组接受死亡审查的移植物1年存活率均大于90%(p=0.343)。高PRA组(3年：79.3%，5年：73.2%)的移植物存活率显著低于低PRA组(3年：91.3%，5年：85.9%)(p=0.003，p=0.013)。高PRA组的总体死亡审查移植物存活率(77.6%)也显著低于低PRA组(87.5%，p=0.007)。我们注意到，在其他负面结果方面，如患者死亡或移植肾功能延迟，两组之间没有统计学差异。
结论：Alemtuzumab和随后的类固醇停药有效地减少了高PRA和低PRA受者之间的短期不良结局差异。然而，第二年后的移植物存活率以及第五年前排斥率的增加表明，在PRA升高的患者中，alemtuzumab的短期效果并不能转化为移植物的长期维持。这一证据表明，在PRA升高的患者中，用激素停药方案诱导阿伦图珠单抗的有效性值得进一步研究。
Introduction: Alemtuzumab, a monoclonal antibody used in approximately 13% of kidney transplants, allows for early glucocorticoid withdrawal. High risk patients, defined by a presence of elevated Panel Reactive Antibody (PRA), are at greater risk for rejection, poorer graft outcomes, and have been shown to benefit from induction with alemtuzumab. The aim of this study is to assess the outcomes of immunologically sensitive kidney transplant recipients after induction with alemtuzumab and early steroid withdrawal.
Methods: A retrospective analysis of 668 transplant recipients, all receiving alemtuzumab induction, from March 2006 through November 2015 was performed. High risk patients (defined as elevated PRA >20%) were compared to those with a low PRA (PRA <20%). Outcomes, such as patient survival, graft survival, and rejection were assessed.
Results: Death-censored graft survival at 1-year was greater than 90% for both groups (p=0.343). Graft survival at 3- and 5- years was significantly lower in the high PRA group (3 years: 79.3%, 5 years: 73.2%) compared to the low PRA group (3 years: 91.3%, 5 years: 85.9%) (p=0.003, p=0.013). Overall death-censored graft survival for the high PRA group (77.6%) was also significantly lower than the low PRA group (87.5%, p=0.007). We noted no statistical difference between groups for other negative outcomes such as patient death or delayed graft function.
Conclusion: Alemtuzumab and subsequent steroid withdrawal is effective at reducing short term poor outcome disparities between high PRA and low PRA recipients. However, graft survival after the second year, and increasing rejection rates prior to the fifth year, demonstrates that the short term effectiveness of alemtuzumab does not translate into long term graft maintenance in patients with elevated PRA. This evidence suggests further investigation into the effectiveness of alemtuzumab induction with steroid withdrawal regimens in patients with an elevated PRA.
因不依从性导致肾同种异体移植失败后再次移植。
DOI：
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发表时间：
1995
期刊：
Transplantation.
影响因子：
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作者：
Troppmann,C;Benedetti,E;Gruessner,RW;Payne,WD;Sutherland,DE;Najarian,JS;Matas,AJ
通讯作者：
Matas,AJ