诱导免疫抑制策略和肺移植后的结果:一个单一中心的经验
Tathagat Narula1, Francisco Alvarez1, Yousif Abdelmoneim2
1Division of Lung Failure and Transplant, Mayo Clinic, Jacksonville, FL, United States of America.
Transplant immunology
|July 10, 2024
概括
接受子抗血球蛋白 (rATG) 或阿勒姆图祖马布诱导免疫抑制的肺移植患者的生存率有所改善. 阿拉姆图祖马布诱导与较高的急性细胞排斥 (ACR) 自由相关.
科学领域:
- 免疫学 免疫学 免疫学
- 移植医学 移植医学
- 肺部病理学 肺部病理学
背景情况:
- 诱导性免疫抑制在80%的肺移植中心使用.
- 缺乏标准化的诱导协议存在于中心内和中心之间.
- 这项研究比较了单剂量子抗胆小细胞球蛋白 (rATG) 与阿莱姆图祖马布 (Alemtuzumab) 与没有诱导.
研究的目的:
- 探索诱导免疫抑制策略与肺移植接受者 (LTR) 结果的关联.
- 为了比较单剂量rATG和alemtuzumab的诱导与没有诱导.
- 评估免疫学和临床结果,包括新的HLA捐赠者特定抗体 (DSA),急性细胞排斥 (ACR),抗体中介排斥 (AMR),慢性肺异位移植功能障碍 (CLAD) 和整体存活率.
主要方法:
- 从2016年至2019年连续174次LTR的回顾性分析.
- 组包括没有诱导 (n=29),阿勒姆图祖马布 (n=22) 和单剂量rATG (n=123).
- 评估新的HLA DSA,ACR,AMR,CLAD和整体生存时间.
主要成果:
- 在没有诱导的情况下,在LTR中较高的中位肺分配得分 (LAS).
- 在没有诱导的情况下,新发现的HLA DSA在44.8%的人群中被检测出来,与rATG的22.8%人群相比,与 Alemtuzumab的40.9%人群相比 (p=0.02).
- 在1,2和3年内,Alemtuzumab诱导显示出明显更高的ACR率自由度.
- 与没有诱导 (p=0.02) 相比,随着rATG或alemtuzumab的诱导,一年整体生存率更高.
结论:
- 用rATG或阿勒姆图祖马布诱导免疫抑制在LTR中提供了明显的好处.
- 诱导阿姆图祖马布可能会降低ACR发生率,特别是在较低维护免疫抑制的情况下.
- 与没有诱导相比,rATG和阿勒姆图祖马布诱导改善了1年生存率.
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