Multivariate analysis of antibody induction therapy and their associated outcomes in live donor kidney transplantation in the recent era

被引:9
作者
Emami, Sina [1 ]
Huang, Edmund [1 ]
Kuo, Hung-Tien [1 ,2 ]
Kamgar, Mohammad [1 ]
Bunnapradist, Suphamai [1 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Div Nephrol, Los Angeles, CA 90095 USA
[2] Kaohsiung Med Univ, Dept Internal Med, Kaohsiung Med Univ Hosp, Kaohsiung, Taiwan
关键词
acute rejection; antibody induction; graft survival; interleukin-2 receptor antagonist; kidney transplantation; thymoglobulin; RENAL-ALLOGRAFT RECIPIENTS; ACUTE CELLULAR REJECTION; DOUBLE-BLIND; LONG-TERM; BASILIXIMAB; TRIAL; METAANALYSIS; MULTICENTER; SURVIVAL; PLACEBO;
D O I
10.1111/j.1399-0012.2011.01517.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The majority of kidney transplant recipients in the United States receive antibody induction, but its impact on outcomes in living donor transplant is not well-described. We used Organ Procurement and Transplant Network/United Network for Organ Sharing (OPTN/UNOS) data as of November 2009 to compare acute rejection (AR) and graft survival among all primary adult living donor kidney recipients of no antibody induction, antithymocyte globulin (ATG) and interleukin-2 receptor antagonists (IL-2RA) in an earlier era (1998-2002; n = 21 919) and a later era (2003-2008, n = 26 837). The incidence of AR in the overall cohort decreased from 18.5% in 1998 to 8% in 2008. From 1998 to 2002, antibody induction was associated with a decreased risk of acute rejection at six months (RR 0.67, 95% CI 0.62-0.72) and one yr (RR 0.71, 0.65-0.76), while in the recent era, induction was not associated with acute rejection at six months (RR 0.97, 0.88-1.07) or one yr (RR 1.01, 0.91-1.10). There was no difference in graft survival over five yr with antibody induction in either era. Although antibody induction was associated with a decreased risk of AR from 1998 to 2002, it was not associated with a decreased risk of acute rejection from 2003 to 2008, nor was it associated with a difference in graft survival in either era.
引用
收藏
页码:351 / 358
页数:8
相关论文
共 19 条
[1]   Evolution of HLA antibody detection - Technology emulating biology [J].
Bray, RA ;
Nickerson, PW ;
Kerman, RH ;
Gebel, HM .
IMMUNOLOGIC RESEARCH, 2004, 29 (1-3) :41-53
[2]   A randomized, double-blinded comparison of thymoglobulin versus Atgam for induction immunosuppressive therapy in adult renal transplant recipients [J].
Brennan, DC ;
Flavin, K ;
Lowell, JA ;
Howard, TK ;
Shenoy, S ;
Burgess, S ;
Dolan, S ;
Kano, JM ;
Mahon, M ;
Schnitzler, MA ;
Woodward, R ;
Irish, W ;
Singer, GG .
TRANSPLANTATION, 1999, 67 (07) :1011-1018
[3]   Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches [J].
Bunnapradist, S ;
Hong, A ;
Lee, B ;
Takemoto, SK .
TRANSPLANTATION PROCEEDINGS, 2005, 37 (02) :886-888
[4]   The Impact of IL2ra Induction Therapy in Kidney Transplantation Using Tacrolimus- and Mycophenolate-Based Immunosuppression [J].
Gralla, Jane ;
Wiseman, Alexander C. .
TRANSPLANTATION, 2010, 90 (06) :639-644
[5]  
HHS/HRSA/HSB/DOT, 2009, OPTN SRTR ANN REP 19
[6]   Reduction of the occurrence of acute cellular rejection among renal allograft recipients treated with basiliximab, a chimeric anti-interleukin-2-receptor monoclonal antibody [J].
Kahan, BD ;
Rajagopalan, PR ;
Hall, M .
TRANSPLANTATION, 1999, 67 (02) :276-284
[7]   Trends in kidney transplantation over the past decade [J].
Knoll, Greg .
DRUGS, 2008, 68 (Suppl 1) :3-10
[8]   Reappraisal of HLA Antibody Analysis and Crossmatching in Kidney Transplantation [J].
Lee, P. -C. ;
Ozawa, M. ;
Hung, C. -J. ;
Lin, Y. -J. ;
Chang, S. -S. ;
Chou, T. -C. .
TRANSPLANTATION PROCEEDINGS, 2009, 41 (01) :95-98
[9]   Interleukin-2 receptor antibody does not reduce rejection risk in low immunological risk or tacrolimus-treated intermediate immunological risk renal transplant recipients [J].
Lim, Wai H. ;
Chadban, Steve J. ;
Campbell, Scott ;
Dent, Hannah ;
Russ, Graeme R. ;
McDonald, Stephen P. .
NEPHROLOGY, 2010, 15 (03) :368-376
[10]   Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era [J].
Meier-Kriesche, HU ;
Schold, JD ;
Srinivas, TR ;
Kaplan, B .
AMERICAN JOURNAL OF TRANSPLANTATION, 2004, 4 (03) :378-383