BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant rec...BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.展开更多
Objective To investigate the effectiveness and tolerability of immunosuppressive regimen with daclizumab induction therapy. Methods In study group,139 patients received immunosuppressive regimen with daclizumab induct...Objective To investigate the effectiveness and tolerability of immunosuppressive regimen with daclizumab induction therapy. Methods In study group,139 patients received immunosuppressive regimen with daclizumab induction therapy. In historical control group,展开更多
To the Editor:To reduce the risk of acute rejection(AR)after renal transplantation,immunosuppressive induction therapy has been commonly used in the perioperative period.At present,rabbit anti-thymocyte globulin(rATG)...To the Editor:To reduce the risk of acute rejection(AR)after renal transplantation,immunosuppressive induction therapy has been commonly used in the perioperative period.At present,rabbit anti-thymocyte globulin(rATG)and basiliximab are the two main induction agents used for kidney transplantation.In adult kidney transplantation,the incidence of AR with rATG induction is generally lower than that with basiliximab.[1]Children have different immune systems than adults do.In pediatric kidney transplantation,which induction therapy is more effective in preventing early AR is an important clinical question worth answering.Because there are few reports in this field and differences in the immune systems of children at different ages,we have now conducted a total and age-stratified analysis of Chinese multicenter cohort data to compare the AR rates and other outcomes between rATG and basiliximab induction therapy groups in pediatric deceased-donor kidney transplantation.展开更多
文摘BACKGROUND The use of induction immunosuppression agents has improved kidney transplant outcomes,but selecting the optimal agent remains a point of debate.AIM To compare the long-term outcomes of kidney transplant recipients receiving alemtuzumab vs basiliximab induction,focusing on graft function,acute rejection,infection,malignancy,post-transplant glomerulonephritis,and survival,using a propensity score matched cohort design.METHODS Kidney transplant recipients who received alemtuzumab or basiliximab induction from 2014 to 2019 across two nephrology centres in Northwest England were evaluated.Propensity score matching at a 1:1.5 ratio ensured comparability between cohorts.Baseline characteristics,immunosuppression regimens,and outcomes were analyzed.Linear,binary logistic and Cox proportional hazard regression models.RESULTS A total of 436 recipients were included,with a median follow-up of 5.2 years.The matched cohort(n=262)had a mean age of 51.1±13.5 years;39%were female and 92%were white.There was no significant difference in the cumulative incidence of acute rejection[odds ratio(OR)=2.10;95%CI:0.9-4.9;P=0.110].Compared with basiliximab,alemtuzumab was associated with lower estimated glomerular filtration rate at 12 months(-6.6 mL/minute/1.73 m2;95%CI:-10.5 to-2.7;P<0.001)and higher risks of cytomegalovirus viremia(OR=3.2;95%CI:1.6-6.5;P<0.001),BK viremia(OR=2.4;95%CI:1.1-5.5;P=0.02),post-transplant malignancy(OR=6.2;95%CI:1.6-29.9;P=0.013),and death-censored graft loss(hazard ratio=3.6;95%CI:1.2-11.4;P=0.03).No significant differences were observed in post-transplant glomerulonephritis or recipient mortality.CONCLUSION In this propensity score-matched analysis,alemtuzumab induction was associated with lower graft function at 12 months and higher risks of viral infection,post-transplant malignancy,and graft loss compared with basiliximab.These findings highlight the need for further studies to confirm the long-term safety and effectiveness of alemtuzumab in kidney transplantation.
文摘Objective To investigate the effectiveness and tolerability of immunosuppressive regimen with daclizumab induction therapy. Methods In study group,139 patients received immunosuppressive regimen with daclizumab induction therapy. In historical control group,
基金supported by the Clinical Research Flagship Project of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology(No.2019CR108).
文摘To the Editor:To reduce the risk of acute rejection(AR)after renal transplantation,immunosuppressive induction therapy has been commonly used in the perioperative period.At present,rabbit anti-thymocyte globulin(rATG)and basiliximab are the two main induction agents used for kidney transplantation.In adult kidney transplantation,the incidence of AR with rATG induction is generally lower than that with basiliximab.[1]Children have different immune systems than adults do.In pediatric kidney transplantation,which induction therapy is more effective in preventing early AR is an important clinical question worth answering.Because there are few reports in this field and differences in the immune systems of children at different ages,we have now conducted a total and age-stratified analysis of Chinese multicenter cohort data to compare the AR rates and other outcomes between rATG and basiliximab induction therapy groups in pediatric deceased-donor kidney transplantation.
