Induction immunosuppression strategies and outcomes post-lung transplant: A single center experience

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2024-07-08 DOI:10.1016/j.trim.2024.102081

Tathagat Narula , Francisco Alvarez , Yousif Abdelmoneim , David Erasmus , Zhuo Li , Mohamed Elrefaei

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引用次数: 0

Abstract

Purpose

Currently 80% of lung transplant centers use induction immunosuppression. However, there is a lack of standardization of induction protocols within and across lung transplant centers. This study explores the association of two different induction immunosuppression strategies used at our center [single dose rabbit antithymocyte globulin (rATG) vs. alemtuzumab] compared to no induction with immunologic and clinical outcomes after lung transplantation.

Methods

A total of 174 consecutive lung transplant recipients (LTR) between 2016 and 2019 were included in the analysis. Twenty nine LTR (16.7%) received no induction, 22 LTR (12.6%) received alemtuzumab, 123 LTR (70.6%) received a single dose of rATG; 1.5 mg/kg within 24 h of transplant for induction. All LTR had a negative flow cytometry crossmatch on the day of the transplant. All LTR were assessed for de novo HLA donor-specific antibodies (DSA) development and clinical outcomes, including the risk of acute cellular rejection (ACR), antibody-mediated rejection (AMR), chronic lung allograft dysfunction (CLAD), and overall survival post-transplant.

Results

The median lung allocation score (LAS) was significantly higher in LTR that did not receive Induction immunosuppression (76; range = 35.3–94.3) compared to induction with rATG (41.6; range = 31.6–91) and alemtuzumab (51; range = 33.1–88.2) (p < 0.001). De novo HLA DSA were detected in 50/174 (28.7%) LTR within 12 months post-transplant. They were detected in 13/29 (44.8%) LTR without induction immunosuppression compared to 28/123 (22.8%) and 9/22 (40.9%) LTR with rATG and alemtuzumab induction, respectively (p = 0.02). The percent freedom from ACR rates between LTR who received alemtuzumab induction was significantly higher compared to LTR who received rATG or no induction at 1 (p = 0.02), 2 (p = 0.01) and 3 (p = 0.05) years post-transplant. In addition, the overall 1-year survival rates were significantly higher in LTR who received rATG or alemtuzumab induction compared to LTR without induction immunosuppression (p = 0.02).

Conclusion

Induction immunosuppression strategies utilizing rATG or Alemtuzumab have unique and contrasting benefits in LTR. Combination of alemtuzumab induction and a lower dose of maintenance immunosuppression may reduce the incidence of ACR in LTR. Single-dose rATG or alemtuzumab induction immunosuppression may also improve the 1 year overall LTR survival compared to no induction.

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肺移植后的诱导免疫抑制策略和结果：单中心经验。

目的：目前，80% 的肺移植中心使用诱导免疫抑制。然而，在肺移植中心内部和不同肺移植中心之间，诱导方案缺乏标准化。本研究探讨了本中心使用的两种不同诱导免疫抑制策略[单剂量兔抗胸腺细胞球蛋白（rATG）vs 阿利珠单抗]与无诱导相比与肺移植术后免疫学和临床结果的关系：分析对象包括 2016 年至 2019 年间连续接受肺移植的 174 例受者（LTR）。29 名 LTR（16.7%）未接受诱导，22 名 LTR（12.6%）接受了阿仑妥珠单抗，123 名 LTR（70.6%）在移植后 24 小时内接受了单剂量 rATG；1.5 mg/kg，用于诱导。所有 LTR 在移植当天的流式细胞术交叉配型均为阴性。对所有LTR进行了新的HLA供体特异性抗体（DSA）发展和临床结果评估，包括急性细胞排斥反应（ACR）、抗体介导的排斥反应（AMR）、慢性肺移植功能障碍（CLAD）和移植后总存活率的风险：结果：与使用 rATG（41.6；范围=31.6-91）和阿仑妥珠单抗（51；范围=33.1-88.2）诱导相比，未接受诱导免疫抑制的 LTR 的肺分配评分（LAS）中位数明显更高（76；范围=35.3-94.3）（p 结论：使用 rATG 诱导免疫抑制策略的 LTR 的肺分配评分（LAS）中位数明显高于未接受诱导免疫抑制的 LTR（76；范围=35.3-94.3）：利用 rATG 或阿来姆妥珠单抗的诱导免疫抑制策略在 LTR 中具有独特且截然不同的优势。阿仑妥珠单抗诱导与低剂量维持性免疫抑制相结合可降低 LTR 的 ACR 发生率。与不诱导相比，单剂量 rATG 或阿来珠单抗诱导免疫抑制也可提高 LTR 的 1 年总生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.