Analysis of rabbit anti-thymocyte globulin vs basiliximab induction in pediatric liver transplant recipients
Analysis of rabbit anti-thymocyte globulin vs basiliximab induction in pediatric liver transplant recipients
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DOI：
10.1111/petr.13573
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发表时间：
2019-12-01
影响因子：
1.3
通讯作者：
Horslen, Simon
中科院分区：
文献类型：
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作者：
Newland, David M.;Royston, Macy J.;Horslen, Simon
比较儿科肝移植（LTx）受者诱导免疫抑制的文献有限。这是一项单中心、回顾性队列研究，研究对象为2005年至2016年在我中心接受巴利昔单抗（BSX）或兔抗胸腺细胞球蛋白（rATG）诱导的原发性儿科肝移植患者。维持免疫抑制包括他克莫司+/-皮质类固醇减量。排除包括接受ABO不相容移植物、再次移植和多器官移植。主要结局是第一年内经治疗的活检证实的急性排斥反应（tBPAR）和PTLD的发生率以及LTx后90天内的感染。次要结局包括移植物和患者存活率、首次tBPAR的时间以及LTx后第一年内类固醇耐药排斥反应（SRR）的发生率。最终分析共纳入136例患者，其中57例患者（42%）接受BSX诱导。与接受BSX诱导和6个月皮质类固醇减量的患者相比，接受rATG诱导伴或不伴2周皮质类固醇减量的患者的tBPAR显著更高（55.7% vs 33.3%，P = 0.01）。两组间PTLD、感染、SRR、移植物或患者存活率或至首次tBPAR的时间无差异。在他克莫司维持免疫抑制的情况下，与使用延长皮质类固醇减量的BSX诱导相比，使用rATG诱导（无论是否使用短皮质类固醇减量）与原发性儿科LTx接受者中显著更多的tBPAR相关。
Literature is limited comparing induction immunosuppression in pediatric liver transplant (LTx) recipients. This is a single-center, retrospective cohort study of primary pediatric liver transplants at our center between 2005 and 2016 who received either basiliximab (BSX) or rabbit anti-thymocyte globulin (rATG) induction. Maintenance immunosuppression consisted of tacrolimus +/- a corticosteroid taper. Exclusions included receipt of an ABO-incompatible graft, retransplantation, and multi-organ transplantation. Primary outcomes were incidence of treated biopsy-proven acute rejection (tBPAR) and PTLD within the first year and infections within 90 days of LTx. Secondary outcomes included graft and patient survival, time to first tBPAR, and incidence of steroid-resistant rejection (SRR) within the first year post-LTx. A total of 136 patients were included in the final analysis of which 57 patients (42%) received BSX induction. Patients who received rATG induction with or without a 2-week corticosteroid taper experienced significantly more tBPAR compared to those who received BSX induction with a 6-month corticosteroid taper (55.7% vs 33.3%, P = .01). There were no differences in the incidence of PTLD, infections, SRR, graft or patient survival, or time to first tBPAR between the two groups. Induction with rATG either with or without a short corticosteroid taper was associated with significantly more tBPAR in primary pediatric LTx recipients when compared to BSX induction with a prolonged corticosteroid taper in the setting of maintenance immunosuppression with tacrolimus.